Provider Demographics
NPI:1245860709
Name:WOODS, SAMANTHA SUE (MED)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SUE
Last Name:WOODS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 JACKSON FARISTON RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8334
Mailing Address - Country:US
Mailing Address - Phone:606-682-2916
Mailing Address - Fax:
Practice Address - Street 1:286 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1204
Practice Address - Country:US
Practice Address - Phone:606-219-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY435440101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional