Provider Demographics
NPI:1396325171
Name:WOODY, PETRINA (LCSW, LCDC, EMDR TRN)
Entity type:Individual
Prefix:
First Name:PETRINA
Middle Name:
Last Name:WOODY
Suffix:
Gender:F
Credentials:LCSW, LCDC, EMDR TRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11824 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-6374
Mailing Address - Country:US
Mailing Address - Phone:214-770-2081
Mailing Address - Fax:
Practice Address - Street 1:11824 ALEXANDRIA DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6374
Practice Address - Country:US
Practice Address - Phone:214-770-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX668081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical