Provider Demographics
NPI:1609254663
Name:WOODGEARD, HEIDI DALE (LCAS, LCSWA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:DALE
Last Name:WOODGEARD
Suffix:
Gender:F
Credentials:LCAS, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4256
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-4256
Mailing Address - Country:US
Mailing Address - Phone:336-848-3087
Mailing Address - Fax:336-792-1655
Practice Address - Street 1:3300 BATTLEGROUND AVE STE 202
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-285-7173
Practice Address - Fax:336-285-7174
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS21250101YA0400X
NCP0094921041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)