Provider Demographics
NPI:1780861856
Name:ODELL, JOYCE ANN (MSW, LCSW,)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:ANN
Last Name:ODELL
Suffix:
Gender:F
Credentials:MSW, LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-0622
Mailing Address - Country:US
Mailing Address - Phone:828-659-2504
Mailing Address - Fax:828-659-2504
Practice Address - Street 1:2018 SUGAR HILL RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5284
Practice Address - Country:US
Practice Address - Phone:828-659-2504
Practice Address - Fax:828-659-2504
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0006211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002103Medicaid
NC6368KOtherBCBS
NC2865858BMedicare PIN