Provider Demographics
NPI:1609370600
Name:WOOLDRIDGE, DEBRA MARIE
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MARIE
Other - Last Name:COVINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 STERRETT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24435-2629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 STERRETT RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:VA
Practice Address - Zip Code:24435-2629
Practice Address - Country:US
Practice Address - Phone:540-960-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician