Provider Demographics
NPI:1457607871
Name:WOODBERRY, SHELBRA DOZIER (MS)
Entity Type:Individual
Prefix:MRS
First Name:SHELBRA
Middle Name:DOZIER
Last Name:WOODBERRY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-4914
Mailing Address - Country:US
Mailing Address - Phone:843-431-1100
Mailing Address - Fax:843-431-1103
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-4914
Practice Address - Country:US
Practice Address - Phone:843-431-1100
Practice Address - Fax:843-431-1103
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC376241Medicaid
SC3337Medicare UPIN