Individual
KRISTY ODOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
124 S MAIN ST, SUITE 2C, JONESBORO, GA 30236-3599
(678) 765-9286
Mailing address
124 S MAIN ST, SUITE 2C, JONESBORO, GA 30236-3599
(678) 765-9286
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC009041
GA
101YP2500X
Professional Counselor
LPC009041
GA
Other
Enumeration date
03/13/2017
Last updated
04/22/2017
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