Provider Demographics
NPI:1225739709
Name:WOODY, RUDOLPH (CACII,CODC)
Entity Type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:
Last Name:WOODY
Suffix:
Gender:M
Credentials:CACII,CODC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 NEW YORK AVE. N.W.
Mailing Address - Street 2:5TH FL
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005
Mailing Address - Country:US
Mailing Address - Phone:202-737-6191
Mailing Address - Fax:
Practice Address - Street 1:1313 NEW YORK AVE NW FL W5
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4701
Practice Address - Country:US
Practice Address - Phone:202-737-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACII1174101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)