Provider Demographics
NPI:1851516074
Name:WOODARD, JEFFREY PAUL
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
Last Name:WOODARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10066 OAKTON TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2900
Mailing Address - Country:US
Mailing Address - Phone:571-232-4710
Mailing Address - Fax:
Practice Address - Street 1:2915 HUNTER MILL RD STE 14
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1716
Practice Address - Country:US
Practice Address - Phone:571-289-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002698103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical