Provider Demographics
NPI:1316254923
Name:ODOM, W ERIC (LPC)
Entity type:Individual
Prefix:
First Name:W
Middle Name:ERIC
Last Name:ODOM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4836 WABASH ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-6717
Mailing Address - Country:US
Mailing Address - Phone:504-780-2766
Mailing Address - Fax:504-779-8297
Practice Address - Street 1:4836 WABASH ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-6717
Practice Address - Country:US
Practice Address - Phone:504-780-2766
Practice Address - Fax:504-779-8297
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2144101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)