Provider Demographics
NPI:1174809453
Name:OLIVER, KACEY D (LPC)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:D
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:D
Other - Last Name:CROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2409 HOMER CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2207
Mailing Address - Country:US
Mailing Address - Phone:256-582-3203
Mailing Address - Fax:256-582-4161
Practice Address - Street 1:2409 HOMER CLAYTON DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2207
Practice Address - Country:US
Practice Address - Phone:256-582-3203
Practice Address - Fax:256-582-4161
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health