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General NPI Number Information
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NPI Number | 1649987744
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Entity Type | Organization
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Legal Business Name | GROWTH ODYSSEY LLC
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 610 PLAINVILLE RD NE
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City | ROME
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State | GA
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Zip | 30161-3990
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Country | US
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Telephone | 719-415-3510
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Fax | 719-938-1914
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Provider Business Mailing Address
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Address Line | 610 PLAINVILLE RD NE
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City | ROME
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State | GA
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Zip | 30161-3990
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Country | US
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Telephone | 719-415-3510
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Fax | 719-938-1914
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Authorized Official
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Title or Position | OWNER
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Name | LARRY JAY ALWINE
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Credential | MA, LPC, LAC
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Telephone | 719-415-3510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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