Healthcare Provider Details

I. General information

NPI: 1205814571
Provider Name (Legal Business Name): KAREN ODLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17285 VETERANS MEMORIAL HWY
DUNGANNON VA
24245-3937
US

IV. Provider business mailing address

17285 VETERANS MEMORIAL HWY
DUNGANNON VA
24245-3937
US

V. Phone/Fax

Practice location:
  • Phone: 276-467-2201
  • Fax: 276-467-2673
Mailing address:
  • Phone: 276-467-2201
  • Fax: 276-467-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002976
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: