Provider Demographics
NPI:1396031365
Name:WOODS, JAIME LEE (P-LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LEE
Last Name:WOODS
Suffix:
Gender:F
Credentials:P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SHARON LYNNE WAY
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721
Mailing Address - Country:US
Mailing Address - Phone:614-961-2489
Mailing Address - Fax:
Practice Address - Street 1:33 SHARON LYNNE WAY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8285
Practice Address - Country:US
Practice Address - Phone:614-961-2489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410078Medicaid