Provider Demographics
NPI:1326709510
Name:ODEN, MADDIE MELISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:MADDIE
Middle Name:MELISSA
Last Name:ODEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8715
Mailing Address - Country:US
Mailing Address - Phone:678-677-1165
Mailing Address - Fax:678-696-7971
Practice Address - Street 1:123 EAGLES LANDING PKWY STE C
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5092
Practice Address - Country:US
Practice Address - Phone:678-632-3847
Practice Address - Fax:678-696-7971
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0075461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW007546OtherLICENSURE