Provider Demographics
NPI:1073694469
Name:WOODS, GARY R SR (MA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:R
Last Name:WOODS
Suffix:SR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 7TH ST NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601
Mailing Address - Country:US
Mailing Address - Phone:828-327-3172
Mailing Address - Fax:828-324-2320
Practice Address - Street 1:321 7TH ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5113
Practice Address - Country:US
Practice Address - Phone:828-327-3172
Practice Address - Fax:828-324-2320
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0714103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046KGOtherBC/BS