Provider Demographics
NPI:1295595023
Name:WOODEN, AMIRACLE STARR (LCSWA)
Entity type:Individual
Prefix:
First Name:AMIRACLE
Middle Name:STARR
Last Name:WOODEN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 EVANS RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-9691
Mailing Address - Country:US
Mailing Address - Phone:984-900-6841
Mailing Address - Fax:
Practice Address - Street 1:2821 EVANS RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-9691
Practice Address - Country:US
Practice Address - Phone:984-900-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty