Provider Demographics
NPI:1134881014
Name:VAN DER LEIJ, OLIVIA (LLPC)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
Last Name:VAN DER LEIJ
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 EASTMAN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6793
Mailing Address - Country:US
Mailing Address - Phone:989-631-4092
Mailing Address - Fax:
Practice Address - Street 1:5100 EASTMAN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6793
Practice Address - Country:US
Practice Address - Phone:989-631-4092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009597101YP2500X
MI6451009597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional