Active NPI
Buckley Olsen
- Clinical Social Worker
- Statesville, NC
National Provider Identifier
1114873221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P023430
- Practice address
- 619 Sullivan Rd
Statesville, NC 28677-3437 - Phone
- (847) 454-6393
- NPI assigned
- Mar 10, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | P023430 | NC | Primary |
Addresses
Primary practice location
619 Sullivan Rd
Statesville, NC 28677-3437
Mailing address
619 Sullivan Rd
Statesville, NC 28677-3437
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P023430 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776038400000",
"number": "1114873221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "619 SULLIVAN RD",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286773437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 SULLIVAN RD",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286773437",
"telephone_number": "847-454-6393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSEN",
"first_name": "BUCKLEY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-03-10",
"last_updated": "2026-04-13",
"certification_date": "2026-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P023430",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.