MEDICARE: AUTHENTICALLY U THERAPY & DISCOVERY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1215810304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTHENTICALLY U THERAPY & DISCOVERY, PLLC

Provider Business Mailing Address
First Line	:	531 TIP TOP AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-9153
Country	:	US
Telephone Number	:	910-502-0883
Fax Number	:

Provider Business Practice Location Address
First Line	:	3064 WAKE FOREST RD # 1397
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7844
Country	:	US
Telephone Number	:	910-502-0883
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NIA ODLUM-THOMAS
Credential	:
Telephone Number	:	910-578-4444

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	01/31/2026

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