Provider Demographics
NPI:1598204083
Name:WOOLLEY, DAVID (BA, LADC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WOOLLEY
Suffix:
Gender:M
Credentials:BA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 CANNON DALE CT
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1145
Mailing Address - Country:US
Mailing Address - Phone:952-381-5272
Mailing Address - Fax:
Practice Address - Street 1:5537 CANNON DALE CT
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1145
Practice Address - Country:US
Practice Address - Phone:952-381-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304195101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)