Provider Demographics
NPI:1629588769
Name:KAREN WOODHOUSE, LLC
Entity Type:Organization
Organization Name:KAREN WOODHOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WOODHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-544-4427
Mailing Address - Street 1:100 WILLOW WOOD DR APT A5
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4830
Mailing Address - Country:US
Mailing Address - Phone:757-544-4427
Mailing Address - Fax:
Practice Address - Street 1:919 W 21ST ST STE B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1559
Practice Address - Country:US
Practice Address - Phone:757-622-6794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904006013261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health