Provider Demographics
NPI:1760955348
Name:ODOM, JOLIE ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:ANN
Last Name:ODOM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 PILOT RILEY RD
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-6219
Mailing Address - Country:US
Mailing Address - Phone:984-689-9240
Mailing Address - Fax:
Practice Address - Street 1:1215 JONES FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-5440
Practice Address - Country:US
Practice Address - Phone:984-689-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician