Odyssey Family Counseling Center Corporation
Organization Active NPI Mental Health Counselor · College Park, GA
NPI 1689604605 · NPPES record last updated Sep 14, 2020
Key facts
- NPI
- 1689604605
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Charles Cain Releford Jr.
- Title
- Executive Director
- Phone
- (404) 762-9190
Practitioners 45
-
Pamela Braxton, LCSW
-
Adryane Phillips, LPC
-
Stephanie L. Barnhart, LCSW
-
Lena Scafe, LPC, CADCII
-
Shilpa Shah, LPC
-
Dana Abraham, LCSW
-
Sydney Baird Arthur, LPC
-
Teri Ayewoh, LMSW, CAMS-11
-
S. Bernard Bagley, LCSW
-
Tracy Busse, LPC
-
Stacey Colebrook, RN
-
Shianna Cruz, LAPC
-
Emma Domby, LMSW
-
Kylie Gerks, MS, MFT
-
Jayne' Green, LPC, LMHC, CAMS II
-
Ennisia Tekeisha James, LCSW
-
Katrina Shantell Jones, LAMFT
-
Kevin Ramone Larkins, LPC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D1094277 | Odyssey Family Counseling Center | Certificate of waiver | Jan 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250807002023 | GA | Part B Supplier - Clinic/Group Practice | 3375963663 |
Receives reassigned benefits from 4 practitioners Practice locations: College Park, GA |
National Provider Directory
Locations
1919 John Wesley Ave
College Park, GA 30337
Phone (404) 762-9190
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/odysseycounseling/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | 060-013-D | GA | |
| Mental Health Counselor |
101YM0800X | Yes | ||
| Professional Counselor |
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
Other providers in College Park, GA
- Susan Elizabeth Northrup
- Nova OBGYN, PC
- Oasis Ambulatory Service
- Oasis Home Care
- Oasis Home Care
- Kofi Ofori-Owusu
- Kaisha Ogilvie
- Christain C. Ohagwu
- Ifetayo I. Ojelade
- Freddie Okoye
All providers in College Park, GA · Mental Health Counselor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.