Provider Demographics
NPI:1689025520
Name:ODUM, CATINA M (15923-130)
Entity Type:Individual
Prefix:
First Name:CATINA
Middle Name:M
Last Name:ODUM
Suffix:
Gender:F
Credentials:15923-130
Other - Prefix:
Other - First Name:CATINA
Other - Middle Name:M
Other - Last Name:FREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:15923-130
Mailing Address - Street 1:3707 N RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1673
Mailing Address - Country:US
Mailing Address - Phone:414-967-7006
Mailing Address - Fax:414-976-7020
Practice Address - Street 1:3707 N RICHARDS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1673
Practice Address - Country:US
Practice Address - Phone:414-967-7006
Practice Address - Fax:414-976-7020
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15923-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)