Provider Demographics
NPI:1174009781
Name:WOODARD, CORRETTA
Entity Type:Individual
Prefix:
First Name:CORRETTA
Middle Name:
Last Name:WOODARD
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:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-1023
Mailing Address - Country:US
Mailing Address - Phone:479-321-2818
Mailing Address - Fax:479-358-1448
Practice Address - Street 1:1202 NE MCCLAIN RD STE 117
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3875
Practice Address - Country:US
Practice Address - Phone:479-321-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty