Provider Demographics
NPI:1356780035
Name:WOODBY, ZACHARY (LMSW CAADC)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:WOODBY
Suffix:
Gender:M
Credentials:LMSW CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42815 GARFIELD RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1143
Mailing Address - Country:US
Mailing Address - Phone:586-846-4835
Mailing Address - Fax:586-408-6485
Practice Address - Street 1:42815 GARFIELD RD STE 210
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1143
Practice Address - Country:US
Practice Address - Phone:586-846-4835
Practice Address - Fax:586-408-6485
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010983401041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical