Provider Demographics
NPI:1356915078
Name:WOODSON, AMBER LENORE (LPC)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:LENORE
Last Name:WOODSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-1137
Mailing Address - Country:US
Mailing Address - Phone:817-734-4015
Mailing Address - Fax:
Practice Address - Street 1:209 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-1137
Practice Address - Country:US
Practice Address - Phone:817-734-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73402101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty