Provider Demographics
NPI:1558975862
Name:WOODSON, RAY THAD (LMSW)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:THAD
Last Name:WOODSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 BRUNT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3317
Mailing Address - Country:US
Mailing Address - Phone:443-517-8423
Mailing Address - Fax:
Practice Address - Street 1:107 E 25TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5213
Practice Address - Country:US
Practice Address - Phone:410-558-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00000000OtherALL WALKS OF LIFE