Provider Demographics
NPI:1811974983
Name:ODEN, CORETTA (LCSW)
Entity type:Individual
Prefix:
First Name:CORETTA
Middle Name:
Last Name:ODEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 LOCH CIR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-5529
Mailing Address - Country:US
Mailing Address - Phone:757-880-7307
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 576 JEFFERSON AVE
Practice Address - Street 2:MCDONALD ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604
Practice Address - Country:US
Practice Address - Phone:757-314-7909
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical