Provider Demographics
NPI:1689604605
Name:ODYSSEY FAMILY COUNSELING CENTER CORPORATION
Entity Type:Organization
Organization Name:ODYSSEY FAMILY COUNSELING CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CAIN
Authorized Official - Last Name:RELEFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-762-9190
Mailing Address - Street 1:1919 JOHN WESLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337
Mailing Address - Country:US
Mailing Address - Phone:404-762-9190
Mailing Address - Fax:404-761-9101
Practice Address - Street 1:1919 JOHN WESLEY AVENUE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337
Practice Address - Country:US
Practice Address - Phone:404-762-9190
Practice Address - Fax:404-762-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-013-D101YA0400X
101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty