Provider Demographics
NPI:1770468852
Name:OLIVER, KRISTOPHER
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24387 RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST
Mailing Address - State:NC
Mailing Address - Zip Code:28097-8362
Mailing Address - Country:US
Mailing Address - Phone:216-990-1170
Mailing Address - Fax:
Practice Address - Street 1:24387 RIDGECREST RD
Practice Address - Street 2:
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097-8362
Practice Address - Country:US
Practice Address - Phone:216-990-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101YA0400XOtherADDICTION (SUBSTANCE USE DISORDER)