MEDICARE: NIA ODLUM-THOMAS BSW, MSW, LCSW-A

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	P021375	NC

General Provider Information

NPI Number	:	1962041673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIA ODLUM-THOMAS BSW, MSW, LCSW-A

Provider Business Mailing 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	:

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2019
Last Update Date	:	01/28/2026

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