Provider Demographics
NPI:1447747712
Name:WOOLFOLK, MAHOGANY DESIREE (AAS, LMT)
Entity Type:Individual
Prefix:
First Name:MAHOGANY
Middle Name:DESIREE
Last Name:WOOLFOLK
Suffix:
Gender:F
Credentials:AAS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 W STONY HILL CT APT 2B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6851
Mailing Address - Country:US
Mailing Address - Phone:804-569-5184
Mailing Address - Fax:
Practice Address - Street 1:1221 MALL DR STE 202
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4737
Practice Address - Country:US
Practice Address - Phone:804-569-5184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-22
Last Update Date:2018-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019011549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist