Provider Demographics
NPI:1962705285
Name:ODOM, DACIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DACIA
Middle Name:
Last Name:ODOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DACIA
Other - Middle Name:
Other - Last Name:ODOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO DRAWER 1403
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-1403
Mailing Address - Country:US
Mailing Address - Phone:337-788-7511
Mailing Address - Fax:337-788-7588
Practice Address - Street 1:1822 W 2ND ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4720
Practice Address - Country:US
Practice Address - Phone:337-788-7511
Practice Address - Fax:337-788-7588
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA77611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical