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General NPI Number Information
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NPI Number | 1659911063
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Entity Type | Organization
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Legal Business Name | ODETTA SMILEY, PSYD, LPC, LLC.
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 11/18/2023
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Provider Practice Location Address
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Address Line | 185 RICHARD DAVIS DR STE 102
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City | RICHMOND HILL
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State | GA
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Zip | 31324-3978
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Country | US
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Telephone | 912-304-3051
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Fax | 844-904-0927
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Provider Business Mailing Address
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Address Line | 20 JOSHUA CIR
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City | ELLABELL
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State | GA
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Zip | 31308-7301
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Country | US
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Telephone | 912-655-1811
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ODETTA SMILEY
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Credential | PSY.D.
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Telephone | 478-227-2419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health 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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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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