Provider Demographics
NPI:1710031547
Name:WOODYARD, CHERYL DIANNE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DIANNE
Last Name:WOODYARD
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 311648
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31131-1648
Mailing Address - Country:US
Mailing Address - Phone:404-768-5807
Mailing Address - Fax:770-969-6548
Practice Address - Street 1:3915 CASCADE RD SW
Practice Address - Street 2:SUITE T148
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8512
Practice Address - Country:US
Practice Address - Phone:404-768-5807
Practice Address - Fax:770-969-6548
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional