Provider Demographics
NPI:1376255265
Name:WOODARD, MISTY LEE (RBA, MSW)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LEE
Last Name:WOODARD
Suffix:
Gender:F
Credentials:RBA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:WV
Mailing Address - Zip Code:25880-1509
Mailing Address - Country:US
Mailing Address - Phone:681-422-3338
Mailing Address - Fax:
Practice Address - Street 1:379 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3141
Practice Address - Country:US
Practice Address - Phone:681-422-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker