Provider Demographics
NPI:1144792078
Name:WOODBRIDGE, CASA
Entity Type:Individual
Prefix:
First Name:CASA
Middle Name:
Last Name:WOODBRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FARMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-7453
Mailing Address - Country:US
Mailing Address - Phone:540-446-3291
Mailing Address - Fax:
Practice Address - Street 1:129 FARMINGTON DR
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28574-7453
Practice Address - Country:US
Practice Address - Phone:540-446-3291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0125681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical