Provider Demographics
NPI:1760491591
Name:WOODLEY, CHARLES L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:WOODLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7112 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6012
Mailing Address - Country:US
Mailing Address - Phone:334-280-0114
Mailing Address - Fax:
Practice Address - Street 1:7112 EAGLE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-6012
Practice Address - Country:US
Practice Address - Phone:334-280-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555469WOOMedicaid
AL051555469WOOMedicare ID - Type Unspecified
AL051555469WOOMedicaid