Provider Demographics
NPI:1578751202
Name:WOODALL, CARRIE JEAN
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JEAN
Last Name:WOODALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:JEAN
Other - Last Name:SWAIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:301 CAPRI CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3086
Mailing Address - Country:US
Mailing Address - Phone:864-420-6917
Mailing Address - Fax:864-322-8284
Practice Address - Street 1:301 CAPRI CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3086
Practice Address - Country:US
Practice Address - Phone:864-420-6917
Practice Address - Fax:864-322-8284
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional