Provider Demographics
NPI:1235432428
Name:ODOM, ANN BUSH (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:BUSH
Last Name:ODOM
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 HERRON AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3457
Mailing Address - Country:US
Mailing Address - Phone:828-772-2419
Mailing Address - Fax:
Practice Address - Street 1:121 SHILOH RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1626
Practice Address - Country:US
Practice Address - Phone:828-277-1315
Practice Address - Fax:828-277-1321
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0132611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical