Provider Demographics
NPI:1164591632
Name:WOODS, TIM J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:J
Last Name:WOODS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 7TH AVE STE 204
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4734
Mailing Address - Country:US
Mailing Address - Phone:831-462-0700
Mailing Address - Fax:
Practice Address - Street 1:180 7TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4725
Practice Address - Country:US
Practice Address - Phone:831-462-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS8541171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor