Provider Demographics
NPI:1336611847
Name:SACO, ODELAISYS (LPCA)
Entity Type:Individual
Prefix:
First Name:ODELAISYS
Middle Name:
Last Name:SACO
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 KERLEE ST APT B
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-3673
Mailing Address - Country:US
Mailing Address - Phone:786-416-3602
Mailing Address - Fax:
Practice Address - Street 1:1100 RIDGEFIELD BLVD STE 190
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-6211
Practice Address - Country:US
Practice Address - Phone:828-670-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15561101YM0800X
NCA14464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional