Provider Demographics
NPI:1003892639
Name:O'DELL, NANCY VIVIAN (LPC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:VIVIAN
Last Name:O'DELL
Suffix:
Gender:F
Credentials:LPC
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 1407
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-1407
Mailing Address - Country:US
Mailing Address - Phone:828-361-5631
Mailing Address - Fax:828-835-4593
Practice Address - Street 1:225 VALLEY RIVER AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-2988
Practice Address - Country:US
Practice Address - Phone:828-361-5631
Practice Address - Fax:828-835-4593
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102485Medicaid
NC1398FOtherBLUE CROSS BLUE SHIELD