Provider Demographics
NPI:1295188985
Name:PAM WOODSON PROFESSIONAL COUNSELING, INC.
Entity type:Organization
Organization Name:PAM WOODSON PROFESSIONAL COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-453-0303
Mailing Address - Street 1:116 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-4028
Mailing Address - Country:US
Mailing Address - Phone:479-453-0303
Mailing Address - Fax:479-477-5509
Practice Address - Street 1:116 S FRONT ST
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-4028
Practice Address - Country:US
Practice Address - Phone:479-453-0303
Practice Address - Fax:479-477-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6456-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR211029719Medicaid
AR211029719Medicaid