Provider Demographics
NPI:1053294082
Name:OLIVER, TERESA R (MS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:R
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 CAMPECHE DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-1705
Mailing Address - Country:US
Mailing Address - Phone:678-873-0995
Mailing Address - Fax:
Practice Address - Street 1:519 CAMPECHE DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-1705
Practice Address - Country:US
Practice Address - Phone:678-873-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health