| 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 |
|---|---|
| Provider Enumeration Date | 01/14/2020 |
| Last Update Date | 11/18/2023 |
| Certification Date | 11/18/2023 |
| Medicare PECOS PAC ID | 0446652036 |
|---|---|
| Medicare Enrollment ID | O20210702002523 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659911063 | NPI | - | NPPES |
| 003140039A | Medicaid | GA | |
| 1194082818 | Other | NPI 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (NU) | Secondary |
| 101YP2500X | Counselor - Professional | (NU) | Primary |
| 103T00000X | Psychologist | (NU) | Secondary |
| Provider Name | Robert a Richardson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538331509 PECOS PAC ID: 6901976091 Enrollment ID: I20080602000176 |
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