Provider Demographics
NPI:1104157213
Name:ODIDA,INC.
Entity type:Organization
Organization Name:ODIDA,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:IGWILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-675-8906
Mailing Address - Street 1:3645 MARKETPLACE BLVD STE 130-63
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5747
Mailing Address - Country:US
Mailing Address - Phone:704-999-2089
Mailing Address - Fax:
Practice Address - Street 1:3645 MARKETPLACE BLVD STE 130-63
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5747
Practice Address - Country:US
Practice Address - Phone:704-999-2089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty