Healthcare Provider Details

I. General information

NPI: 1780861856
Provider Name (Legal Business Name): JOYCE ANN ODELL M.S.W., L.C.S.W.,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 SUGAR HILL RD
MARION NC
28752-5284
US

IV. Provider business mailing address

PO BOX 622
MARION NC
28752-0622
US

V. Phone/Fax

Practice location:
  • Phone: 828-659-2504
  • Fax: 828-659-2504
Mailing address:
  • Phone: 828-659-2504
  • Fax: 828-659-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC000621
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6002103
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier6368K
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: