Provider Demographics
NPI:1437583895
Name:WOODWARD, DAVIS (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVIS
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 SPRINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5435
Mailing Address - Country:US
Mailing Address - Phone:337-540-5677
Mailing Address - Fax:
Practice Address - Street 1:1207 SPRINGWOOD LN
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5435
Practice Address - Country:US
Practice Address - Phone:337-540-5677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4308101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor