Active NPI
Shivonne A Odom, LCPC
- Professional Counselor
- Washington, DC
National Provider Identifier
1013206135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LC3868
- Practice address
- 306 Atlantic St SE
#3
Washington, DC 20032-3098 - Phone
- (508) 272-6348
- NPI assigned
- Mar 29, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LC3868 | MD | Primary |
| Counselor | 101Y00000X | PRC14590 | DC |
Addresses
Primary practice location
306 Atlantic St SE
#3
Washington, DC 20032-3098
Mailing address
306 Atlantic St SE
#3
Washington, DC 20032-3098
Phone (508) 272-6348
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PRC14590 | DC | MD | Counselor |
| LC3868 | MD | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478131200000",
"number": "1013206135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 ATLANTIC ST SE",
"address_2": "#3",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200323098",
"telephone_number": "508-272-6348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 ATLANTIC ST SE",
"address_2": "#3",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200323098",
"telephone_number": "508-272-6348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOM",
"first_name": "SHIVONNE",
"middle_name": "A",
"name_prefix": "Miss",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-29",
"last_updated": "2016-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LC3868",
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "DC",
"license": "PRC14590",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.