Provider Demographics
NPI:1275561938
Name:WOODMANSEE, JOHN JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAY
Last Name:WOODMANSEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 THORNDALE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3536
Mailing Address - Country:US
Mailing Address - Phone:336-768-5992
Mailing Address - Fax:
Practice Address - Street 1:3935 THORNDALE DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3536
Practice Address - Country:US
Practice Address - Phone:336-768-5992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC191103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist