Provider Demographics
NPI:1285832980
Name:WOODS, MARY E (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:WOODS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 CLEARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4954
Mailing Address - Country:US
Mailing Address - Phone:804-773-9972
Mailing Address - Fax:804-773-9972
Practice Address - Street 1:1249 CLEARWOOD RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-4954
Practice Address - Country:US
Practice Address - Phone:804-773-9972
Practice Address - Fax:804-773-9972
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1010Medicaid
SCQ35687D896Medicare PIN