Provider Demographics
NPI:1235178724
Name:WOODALL, ANTHONY M (MA, LPC, LCAS)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:M
Last Name:WOODALL
Suffix:
Gender:M
Credentials:MA, LPC, LCAS
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 1835
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-1835
Mailing Address - Country:US
Mailing Address - Phone:919-938-0921
Mailing Address - Fax:919-938-3807
Practice Address - Street 1:111 N 2ND ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3933
Practice Address - Country:US
Practice Address - Phone:919-938-0921
Practice Address - Fax:919-938-3807
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3041101YP2500X
NC632101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1165YOther3
577331OtherVALUE OPTION
NC0177COtherBCBSNC GROUP
NC2076854Other2
NC6102389Medicaid