Provider Demographics
NPI:1437399631
Name:WOODVILLE, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WOODVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11724 KRISLOR DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-9300
Mailing Address - Country:US
Mailing Address - Phone:501-776-8338
Mailing Address - Fax:
Practice Address - Street 1:11724 KRISLOR DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-9300
Practice Address - Country:US
Practice Address - Phone:501-776-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker