MRS. JACQUELINE ODUSELU (NPI# 1922467414) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922467414 |
| Entity Type | Individual |
| Full Name | MRS. JACQUELINE ODUSELU |
| Credential | MS, NCC, LPC, CPCS |
| Practice Address |
1827 Brackendale Rd Nw Kennesaw GA 30152-7747 |
| Mailing Address |
Po Box 2656 Acworth GA 30102-0012 |
| Practice Telephone | 6785821469 |
| Practice Fax Number | 7702122210 |
| Mailing Telephone | 4046445523 |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2020-07-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | LPC008829 | GA | Behavioral Health & Social Service Providers |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
LPC008829 | GA | Behavioral Health & Social Service Providers |
| N | 101YP1600X |
Counselor Specialization: Pastoral |
LPC008829 | GA | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
LPC008829 | GA | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1905 Woodstock Rd, Suite 7150, Roswell, GA 300755616 | 4046445523 |
| Street Address |
1827 BRACKENDALE RD NW |
| City | KENNESAW |
| State | GA |
| Zip Code | 30152-7747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821647124 | Ashley Dover | Nurse Practitioner | 1300 Ridenour Blvd, Suite 300, Kennesaw, GA 30152 | 2019-09-09 |
| 1205306891 | Lashanda Denise Moore | Nurse Practitioner | 1600 Kennesaw Due West Rd Nw #205, Kennesaw, GA 30152 | 2018-11-27 |
| 1265901094 | Focused Loving Home Care Services LLC | In Home Supportive Care | 2151 Marne Glen Nw, Kennesaw, GA 30152 | 2018-11-22 |
| 1083199152 | Raven Ashley Thomas | Behavioral Analyst | 1619 Collins Rd Nw Ste 500, Kennesaw, GA 30152 | 2018-09-25 |
| 1821592593 | Eseovhe Egborge PC | Clinic/Center | 1600 Kennesaw Due West Rd Nw Ste 205, Kennesaw, GA 30152 | 2018-03-19 |
| 1184143059 | Kennesaw Mountain Dental Associates | Dentist | 1815 Old 41 Hwy, Ste 310, Kennesaw, GA 30152 | 2017-09-12 |
| 1265955983 | Deborah Ruth Stern Compton | Registered Nurse | 1291 Stanley Rd., Kennesaw, GA 30152 | 2017-07-25 |
| 1912452939 | Mak Anesthesia Holdings LLC | Anesthesiology | 1300 Ridenour Blvd., Ste. 300, Kennesaw, GA 30152 | 2016-08-19 |
| 1528430279 | Tineka Nichol Wyckoff | Counselor | 1967 Lake Heights Circle, Kennesaw, GA 30152 | 2015-10-21 |
| 1669753992 | American Current Care Pa | Clinic/Center | 2953 Cobb Parkway, Suite 400, Kennesaw, GA 30152 | 2011-08-31 |
| Find all providers in zip 30152 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982241451 | Anila Asghar Malik | Counselor | 3164 Kirkwood Dr Nw, Kennesaw, GA 30144-2354 | 2019-12-04 |
| 1386289213 | Sarah Michelle Howell | Counselor | 1301 Shiloh Rd Nw Ste 340, Kennesaw, GA 30144-7151 | 2019-11-14 |
| 1558905992 | Edward Patrick Craven Jr. | Counselor | 3745 Cherokee St Nw Ste 607, Kennesaw, GA 30144-6733 | 2019-10-29 |
| 1831698869 | In Control Counseling Services, LLC | Counselor | 3895 Mountain View Rd Nw, Kennesaw, GA 30152-2388 | 2018-02-05 |
| 1619407020 | Pauline Waweru | Counselor | 1301 Shiloh Rd Nw Ste 1811, Kennesaw, GA 30144-7171 | 2017-06-18 |
| 1285161463 | Jennifer Y Hahn | Counselor | 3070 N Main St Nw Ofc 10, Kennesaw, GA 30144-2756 | 2017-05-18 |
| 1427590090 | Jennifer Lee Wells | Counselor | 1425 Ridenour Blvd Nw Apt 8108, Kennesaw, GA 30152-4570 | 2016-11-13 |
| 1104279637 | Gloria Dunston | Counselor | 1575 Ridenour Pkwy Nw, Apt. 1823, Kennesaw, GA 30152-4714 | 2016-07-20 |
| 1972961357 | Brent C Harris | Counselor | 4010 Sumit Wood Dr Nw, Kennesaw, GA 30152-4155 | 2016-02-01 |
| 1760888978 | Tiffany Webb | Counselor | 1301 Shiloh Rd Nw Ste 840, Kennesaw, GA 30144-7156 | 2014-11-15 |
| Find all providers in KENNESAW | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.