Healthcare Provider Details

I. General information

NPI: 1356816961
Provider Name (Legal Business Name): ADRIAN L. ODOM MA, ADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 PALMETTO PARK BLVD STE D
LEXINGTON SC
29072-7969
US

IV. Provider business mailing address

PO BOX 388
WINNSBORO SC
29180-0388
US

V. Phone/Fax

Practice location:
  • Phone: 803-359-0666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: