Provider Demographics
NPI:1427405356
Name:WOODSON, TABITHA MONIQUE (LPC)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:MONIQUE
Last Name:WOODSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:MONIQUE
Other - Last Name:JOYNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8767 SEMINOLE TRL STE 101
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-3494
Mailing Address - Country:US
Mailing Address - Phone:434-990-1744
Mailing Address - Fax:434-939-9401
Practice Address - Street 1:8767 SEMINOLE TRL STE 101
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-3494
Practice Address - Country:US
Practice Address - Phone:434-990-1744
Practice Address - Fax:434-939-9401
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006457101YP2500X
101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty