Provider Demographics
NPI:1285956615
Name:ODOM, AUDWIN LEWIS (MSW, CADC)
Entity type:Individual
Prefix:MR
First Name:AUDWIN
Middle Name:LEWIS
Last Name:ODOM
Suffix:
Gender:M
Credentials:MSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902A MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-4605
Mailing Address - Country:US
Mailing Address - Phone:302-655-7108
Mailing Address - Fax:302-655-0689
Practice Address - Street 1:1902A MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4605
Practice Address - Country:US
Practice Address - Phone:302-655-7108
Practice Address - Fax:302-655-0689
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1047101YA0400X
DE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical