Provider Demographics
NPI:1003937491
Name:WOODARD, THOMAS ANDREW (LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:WOODARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 CLINT NORRIS RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-8843
Mailing Address - Country:US
Mailing Address - Phone:828-265-1455
Mailing Address - Fax:828-265-1535
Practice Address - Street 1:368 CLINT NORRIS RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-8843
Practice Address - Country:US
Practice Address - Phone:828-265-1455
Practice Address - Fax:828-265-1535
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4392101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102354Medicaid
NC138YWOtherBLUE CROSS BLUE SHIELD NC