Provider Demographics
NPI:1023066826
Name:WOODARD, PAUL ANTHONY (LCSW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANTHONY
Last Name:WOODARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5812 MAYBROOK CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-6946
Mailing Address - Country:US
Mailing Address - Phone:804-364-2819
Mailing Address - Fax:
Practice Address - Street 1:19254 ROGERS CLARK BLVD
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-4010
Practice Address - Country:US
Practice Address - Phone:804-633-9997
Practice Address - Fax:804-633-7031
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945123Medicaid
VA0006359OtherTRICARE
VA287193OtherANTHEM
VA291352OtherMDIPA
VA089857OtherSENTARA
VA800003002Medicare ID - Type Unspecified