Provider Demographics
NPI:1679381735
Name:LEIB, OLIVIA ANNE (CDCA)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANNE
Last Name:LEIB
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 AMERICANA DR APT 109
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44224-5618
Mailing Address - Country:US
Mailing Address - Phone:330-348-3282
Mailing Address - Fax:
Practice Address - Street 1:4261 AMERICANA DR APT 109
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44224-5618
Practice Address - Country:US
Practice Address - Phone:330-348-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH190257101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)