Provider Demographics
NPI:1497469886
Name:WOODHAM, BRITTANY A
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:A
Last Name:WOODHAM
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 1:4145 W VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7858
Mailing Address - Country:US
Mailing Address - Phone:480-227-7786
Mailing Address - Fax:
Practice Address - Street 1:4145 W VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7858
Practice Address - Country:US
Practice Address - Phone:480-227-7786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional