Provider Demographics
NPI:1548805211
Name:WOODS, TEQUILLA BROWN (MS COUNSELING)
Entity Type:Individual
Prefix:
First Name:TEQUILLA
Middle Name:BROWN
Last Name:WOODS
Suffix:
Gender:F
Credentials:MS COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 MOBILE AVE LOT 1
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-3264
Mailing Address - Country:US
Mailing Address - Phone:229-446-0878
Mailing Address - Fax:
Practice Address - Street 1:724 MOBILE AVE LOT 1
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-3264
Practice Address - Country:US
Practice Address - Phone:229-446-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor