Provider Demographics
NPI:1558594770
Name:WOODSON, DANNAJESELLE KEIVETTE (ND, MSOM)
Entity Type:Individual
Prefix:MS
First Name:DANNAJESELLE
Middle Name:KEIVETTE
Last Name:WOODSON
Suffix:
Gender:F
Credentials:ND, MSOM
Other - Prefix:MS
Other - First Name:JESSY
Other - Middle Name:K
Other - Last Name:WOODSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND, MSOM
Mailing Address - Street 1:1727 GEORGES LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3313
Mailing Address - Country:US
Mailing Address - Phone:215-292-1282
Mailing Address - Fax:
Practice Address - Street 1:2288 SECOND STREET PIKE
Practice Address - Street 2:SUITE 6
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-4108
Practice Address - Country:US
Practice Address - Phone:215-598-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNAT100862101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor