Provider Demographics
NPI:1043220403
Name:TOMPKINS WOODSON, PATRICIA LYNN (MED; LPC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LYNN
Last Name:TOMPKINS WOODSON
Suffix:
Gender:F
Credentials:MED; LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10773
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5013
Mailing Address - Country:US
Mailing Address - Phone:434-836-6689
Mailing Address - Fax:434-685-1543
Practice Address - Street 1:1115 FRANKLIN TPKE
Practice Address - Street 2:AK FERRELL BUILDING, SUITES 11 & 12
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-1362
Practice Address - Country:US
Practice Address - Phone:434-836-6689
Practice Address - Fax:434-685-1543
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701003091OtherLPC LICENSE #
VA5411475Medicaid