Provider Demographics
NPI:1962041673
Name:ODLUM-THOMAS, NIA (BSW, MSW, LCSW-A)
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:
Last Name:ODLUM-THOMAS
Suffix:
Gender:F
Credentials:BSW, MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 TIP TOP AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9153
Mailing Address - Country:US
Mailing Address - Phone:910-578-9444
Mailing Address - Fax:
Practice Address - Street 1:1903 BRAGG BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4359
Practice Address - Country:US
Practice Address - Phone:910-853-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0213751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty