| Doctor Name: | MISS SHIVONNE A ODOM |
| NPI Number: | 1013206135 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | LC3868 |
| Business Practice Address: | 7610 Pennsylvania Ave Suite 103 Forestville, MD - 207474701 |
| Business Phone Number: | 3014201972 |
| Business Fax Number: | 3014201973 |
| Mailing Address: | 4405 1st Pl Ne, Apt 4 WASHINGTON |
| State: | DC |
| Postal Code: | 200114957 |
| Phone Number: | 5082726348 |
| Fax Number: | |
| NPI Enumeration Date: | 03/29/2011 |
| NPI Last Update Date: | 03/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LC3868 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |