Provider Demographics
NPI:1245446442
Name:WOODFORD, MARK STEPHEN (PHD, LPC, MAC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:WOODFORD
Suffix:
Gender:M
Credentials:PHD, LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 PINE LN
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2820
Mailing Address - Country:US
Mailing Address - Phone:215-321-7918
Mailing Address - Fax:
Practice Address - Street 1:2000 PENNINGTON RD
Practice Address - Street 2:TCNJ, 327 FORCINA HALL
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1104
Practice Address - Country:US
Practice Address - Phone:609-771-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00290700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional