Provider Demographics
NPI:1417107350
Name:REEVES WOODALL, CAROL (BCABA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:REEVES WOODALL
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 BRADWATER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3704
Mailing Address - Country:US
Mailing Address - Phone:703-635-9075
Mailing Address - Fax:
Practice Address - Street 1:3938 BRADWATER ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3704
Practice Address - Country:US
Practice Address - Phone:703-635-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0-07-2427103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities