Provider Demographics
NPI:1902874894
Name:OLIVER, DEREK CHRISTOPHER (PHD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:CHRISTOPHER
Last Name:OLIVER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HOSPITAL RD
Mailing Address - Street 2:ROOM 13A-10
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-5602
Mailing Address - Fax:706-787-1458
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:ROOM 13A-10
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-5602
Practice Address - Fax:706-787-1458
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1279103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical