Provider Demographics
NPI:1013236959
Name:WOODARD, DIANA ALVIDREZ (MA)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:ALVIDREZ
Last Name:WOODARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13706 RESEARCH BLVD
Mailing Address - Street 2:STE 211A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1882
Mailing Address - Country:US
Mailing Address - Phone:512-797-2802
Mailing Address - Fax:
Practice Address - Street 1:13706 RESEARCH BLVD
Practice Address - Street 2:STE 211A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1882
Practice Address - Country:US
Practice Address - Phone:512-797-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional