Provider Demographics
NPI:1689931396
Name:WOODRUFF, AMY S (LCMHC, LADC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 BERT WHITE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05462-9757
Mailing Address - Country:US
Mailing Address - Phone:802-355-0850
Mailing Address - Fax:
Practice Address - Street 1:1 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3456
Practice Address - Country:US
Practice Address - Phone:802-847-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0125759101YA0400X
VT068.0069363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)