Provider Demographics
NPI:1013643030
Name:ODOM, ALLISON SABRA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:SABRA
Last Name:ODOM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5385 W CLEVENGER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-8486
Mailing Address - Country:US
Mailing Address - Phone:479-597-6181
Mailing Address - Fax:
Practice Address - Street 1:500 ELMDALE DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-3005
Practice Address - Country:US
Practice Address - Phone:877-455-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12201-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical