Odetta Smiley, PSYD, LPC, LLC.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

ODETTA SMILEY, PSYD, LPC, LLC.

Practice address

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

Phone

(912) 304-3051

Fax

(844) 904-0927

NPI assigned

Jan 14, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Odetta Smiley, PSY.D.NPI 1194082818

Title

Psychologist

Phone

(478) 227-2419

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Anthony Richardson, PSY.D.

  • Clinical Psychologist
  • Richmond Hill, GA
  • NPI 1538331509
  Medicare reassignment Care Compare group NPD
• Odetta Smiley, PSYD, LPC, CCMHC,MAC

  • Professional Counselor
  • Richmond Hill, GA
  • NPI 1194082818
  Care Compare group NPD Authorized official
• Marion Curtis

  • Psychiatric/Mental Health Nurse Practitioner
  • Warner Robins, GA
  • NPI 1841771011
  NPD

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

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700265600000",
    "number": "1659911063",
    "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"
        },
        {
            "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": "877-299-6815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ODETTA SMILEY, PSYD, LPC, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-14",
        "last_updated": "2023-11-18",
        "certification_date": "2023-11-18",
        "status": "A",
        "authorized_official_last_name": "SMILEY",
        "authorized_official_first_name": "ODETTA",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "478-227-2419",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003140039A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI 1",
            "identifier": "1194082818",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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 Nov 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.