Provider Demographics
NPI:1841764792
Name:WOODEN, MYESHA MEKIA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MYESHA
Middle Name:MEKIA
Last Name:WOODEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 MAPLE SHADE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2154
Mailing Address - Country:US
Mailing Address - Phone:410-961-9371
Mailing Address - Fax:
Practice Address - Street 1:3100 LORD BALTIMORE DR STE 208
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2882
Practice Address - Country:US
Practice Address - Phone:410-701-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional