Provider Demographics
NPI:1215530704
Name:ODDESTY K LLC
Entity type:Organization
Organization Name:ODDESTY K LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ODDESTY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LANGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:205-528-8162
Mailing Address - Street 1:PO BOX 383272
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35238-3272
Mailing Address - Country:US
Mailing Address - Phone:205-528-8162
Mailing Address - Fax:
Practice Address - Street 1:2330 HIGHLAND AVE S STE L2
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2912
Practice Address - Country:US
Practice Address - Phone:205-528-8162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health