Provider Demographics
NPI:1336471960
Name:WOODRUFF, MANUELA (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:MANUELA
Middle Name:
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 DOVE FIELD CT
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1309
Mailing Address - Country:US
Mailing Address - Phone:770-609-8777
Mailing Address - Fax:
Practice Address - Street 1:6151 DOVE FIELD CT
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1309
Practice Address - Country:US
Practice Address - Phone:770-609-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-07
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5751103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst