Healthcare Provider Details

I. General information

NPI: 1962705285
Provider Name (Legal Business Name): DACIA ODOM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DACIA ODOM LCSW

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 W 2ND ST
CROWLEY LA
70526-4720
US

IV. Provider business mailing address

PO DRAWER 1403
CROWLEY LA
70527-1403
US

V. Phone/Fax

Practice location:
  • Phone: 337-788-7511
  • Fax: 337-788-7588
Mailing address:
  • Phone: 337-788-7511
  • Fax: 337-788-7588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7761
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: