Provider Demographics
NPI:1063697431
Name:O'DONNELL, RICHARD J (LPC, NCGC II)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:LPC, NCGC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 RIVAGE PROMENADE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2751
Mailing Address - Country:US
Mailing Address - Phone:330-208-7434
Mailing Address - Fax:330-632-5303
Practice Address - Street 1:272 N FRONT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4059
Practice Address - Country:US
Practice Address - Phone:330-208-7434
Practice Address - Fax:910-632-5303
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5432101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional