Provider Demographics
NPI:1679332191
Name:SHEALY, OLIVIA (LCMHCA, CCTP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:SHEALY
Suffix:
Gender:F
Credentials:LCMHCA, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16512
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28816-0512
Mailing Address - Country:US
Mailing Address - Phone:828-273-7785
Mailing Address - Fax:
Practice Address - Street 1:6314 BIG PINE RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-7682
Practice Address - Country:US
Practice Address - Phone:828-273-7785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19705101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health