Provider Demographics
NPI:1003050840
Name:WOODARD, CAROLYN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 WALNUT ST
Mailing Address - Street 2:202
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2677
Mailing Address - Country:US
Mailing Address - Phone:478-254-3751
Mailing Address - Fax:478-254-3752
Practice Address - Street 1:688 WALNUT ST
Practice Address - Street 2:202
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2677
Practice Address - Country:US
Practice Address - Phone:478-254-3751
Practice Address - Fax:478-254-3752
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004390101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional