Provider Demographics
NPI:1548787229
Name:WOODS, MARY ETHEL (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ETHEL
Last Name:WOODS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9153 TWO NOTCH RD STE C11
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5852
Mailing Address - Country:US
Mailing Address - Phone:803-339-0709
Mailing Address - Fax:
Practice Address - Street 1:9153 TWO NOTCH RD STE C11
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5852
Practice Address - Country:US
Practice Address - Phone:803-339-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health