Odetta Smiley, Psyd, Lpc, Llc. | |
185 Richard Davis Dr Ste 102 Richmond Hill GA 31324-3978 | |
(912) 304-3051 | |
(844) 904-0927 |
Full Name | Odetta Smiley, Psyd, Lpc, Llc. |
---|---|
Speciality | Counselor |
Location | 185 Richard Davis Dr Ste 102, Richmond Hill, Georgia |
Authorized Official Name and Position | Odetta Smiley (PSYCHOLOGIST) |
Authorized Official Contact | 4782272419 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Odetta Smiley, Psyd, Lpc, Llc. 20 Joshua Cir Ellabell GA 31308-7301 Ph: (912) 655-1811 | Odetta Smiley, Psyd, Lpc, Llc. 185 Richard Davis Dr Ste 102 Richmond Hill GA 31324-3978 Ph: (912) 304-3051 |
NPI Number | 1659911063 |
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Provider Enumeration Date | 01/14/2020 |
Last Update Date | 11/18/2023 |
Certification Date | 11/18/2023 |
Medicare PECOS PAC ID | 0446652036 |
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Medicare Enrollment ID | O20210702002523 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659911063 | NPI | - | NPPES |
003140039A | Medicaid | GA | |
1194082818 | Other | NPI 1 |
Provider Name | Robert A Richardson |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1538331509 PECOS PAC ID: 6901976091 Enrollment ID: I20080602000176 |
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