Healthcare Provider Details

I. General information

NPI: 1649987744
Provider Name (Legal Business Name): GROWTH ODYSSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PLAINVILLE RD NE
ROME GA
30161-3990
US

IV. Provider business mailing address

610 PLAINVILLE RD NE
ROME GA
30161-3990
US

V. Phone/Fax

Practice location:
  • Phone: 719-415-3510
  • Fax: 719-938-1914
Mailing address:
  • Phone: 719-415-3510
  • Fax: 719-938-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LARRY JAY ALWINE
Title or Position: OWNER
Credential: MA, LPC, LAC
Phone: 719-415-3510