Provider Demographics
NPI:1689395022
Name:WOODS, MAX AWSTEN
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:AWSTEN
Last Name:WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:JEAN
Other - Last Name:HARTWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2002 JEFFERSON AVE SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1023
Mailing Address - Country:US
Mailing Address - Phone:317-982-4031
Mailing Address - Fax:
Practice Address - Street 1:1690 BELTLINE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5505
Practice Address - Country:US
Practice Address - Phone:256-617-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-22-233552106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician