Provider Demographics
NPI:1639429905
Name:ODELL, DONNA (CSAC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:ODELL
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5470
Mailing Address - Country:US
Mailing Address - Phone:336-629-7774
Mailing Address - Fax:336-629-7776
Practice Address - Street 1:131 DAVIS ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5470
Practice Address - Country:US
Practice Address - Phone:336-629-7774
Practice Address - Fax:336-629-7776
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)