Odetta Smiley, PSYD, LPC, CCMHC,MAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC004492 Issued in GA

Practice address

185 Richard Davis Dr Ste 102
Richmond Hill, GA 31324-3978

Phone

(912) 304-3051

Fax

(844) 904-0927

NPI assigned

Apr 19, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Group practices

Odetta Smiley, PSYD, LPC, LLC.Group PAC ID 0446652036, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Odetta Smiley, PSYD, LPC, LLC.

  • Professional Counselor
  • Richmond Hill, GA
  • NPI 1659911063
  Care Compare group NPD Authorized official
• Curtis Behavioral Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Warner Robins, GA
  • NPI 1942852512
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1194082818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 JOSHUA CIR",
            "city": "ELLABELL",
            "state": "GA",
            "postal_code": "313087301",
            "telephone_number": "912-655-1811",
            "fax_number": "844-904-0927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 RICHARD DAVIS DR STE 102",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313243978",
            "telephone_number": "912-304-3051",
            "fax_number": "844-904-0927"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2052 Watson Blvd",
            "address_purpose": "LOCATION",
            "city": "Warner Robins",
            "state": "GA",
            "postal_code": "310933625",
            "country_code": "US",
            "telephone_number": "478-227-2419",
            "fax_number": "844-904-0927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMILEY",
        "first_name": "ODETTA",
        "name_prefix": "Dr.",
        "credential": "PSYD, LPC, CCMHC,MAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-19",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": "507430",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC004492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1194082818",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003228219A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI 2",
            "identifier": "1659911063",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Shelton Sizemore III, FNP
• Makayla Skinner
• Steven Slack, PHARMD
• Tekelia Sloan, SLP
• Smile Innovations
• Carolyn Smith
• Dawana D. Smith
• Elisha Smith
• Erika Yvonne Smith, LPN
• Heather Rutledge Smith, M.C.D. CCC-SLP

• Professional Counselor in Richmond Hill, GA
• Providers in Richmond Hill, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.