Provider Demographics
NPI:1255686051
Name:WOODBRIDGE COUNSELING, LLC
Entity Type:Organization
Organization Name:WOODBRIDGE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:814-336-2743
Mailing Address - Street 1:1041 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-4324
Mailing Address - Country:US
Mailing Address - Phone:814-336-2743
Mailing Address - Fax:866-986-2743
Practice Address - Street 1:1041 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-4324
Practice Address - Country:US
Practice Address - Phone:814-336-2743
Practice Address - Fax:866-986-2743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005764101YP2500X
PAPS005187L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty