NPIMap

Organization Active NPI

Odyssey Family Counseling Center Corporation

  • Mental Health Counselor
  • College Park, GA
National Provider Identifier
1689604605
Registry record updated Sep 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
ODYSSEY FAMILY COUNSELING CENTER CORPORATION
Practice address
1919 John Wesley Avenue
College Park, GA 30337
Phone
(404) 762-9190
Fax
(404) 762-9101
NPI assigned
Jul 4, 2006
Last updated
Sep 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2020

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

Authorized official

Name
Mr. Charles Cain Releford Jr.
Title
Executive Director
Phone
(404) 762-9190

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 060-013-D GA
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X

Addresses

Primary practice location

1919 John Wesley Avenue
College Park, GA 30337

Mailing address

1919 John Wesley Avenue
College Park, GA 30337
Phone (404) 762-9190

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250807002023 GA Part B Supplier - Clinic/Group Practice 3375963663 Receives reassigned benefits from 4 practitioners
Practice locations: College Park, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1094277Odyssey Family Counseling Center1919 John Wesley Avenue Attn Susan Stone RN, College Park, GA 30337Certificate of waiverJan 14, 2027

National Provider Directory

National Provider Directory

Locations

1919 John Wesley Ave
College Park, GA 30337
Phone (404) 762-9190

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/odysseycounseling/r4/

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600041600000",
    "number": "1689604605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 JOHN WESLEY AVENUE",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "30337",
            "telephone_number": "404-762-9190",
            "fax_number": "404-761-9101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 JOHN WESLEY AVENUE",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "30337",
            "telephone_number": "404-762-9190",
            "fax_number": "404-762-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODYSSEY FAMILY COUNSELING CENTER CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "RELEFORD",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "CAIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "404-762-9190",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "060-013-D",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in College Park, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.