Provider Demographics
NPI:1669888798
Name:WOODSON, JOSELYN CECELIA (LCPC)
Entity type:Individual
Prefix:
First Name:JOSELYN
Middle Name:CECELIA
Last Name:WOODSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 W BOUGHTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1898
Mailing Address - Country:US
Mailing Address - Phone:630-685-4053
Mailing Address - Fax:
Practice Address - Street 1:404 W BOUGHTON RD STE B
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:630-685-4053
Practice Address - Fax:630-863-7403
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008531101YP2500X, 101YP2500X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid