Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4086 | NC |
NPI | 1003892639 |
---|---|
Provider Name | Ms. Nancy Vivian O'dell |
First Address | Murphy, NC 28906-1407 |
Second Address | Murphy, NC 28906-2988 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1398F | BLUE CROSS BLUE SHIELD (01) | NC |
6102485 | (05) | NC |