Provider Demographics
NPI:1679064356
Name:WOODRUFF, VICTORIA REESE (LPC, RN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:REESE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 DEMING CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2954
Mailing Address - Country:US
Mailing Address - Phone:706-474-2056
Mailing Address - Fax:770-495-9745
Practice Address - Street 1:41 PERIMETER CTR E
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30346-1910
Practice Address - Country:US
Practice Address - Phone:770-871-3177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN296824163W00000X
GALPC012627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse