Provider Demographics
NPI:1740438829
Name:WOODFORK, DANA
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:WOODFORK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15338 W POINSETTIA DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5282
Mailing Address - Country:US
Mailing Address - Phone:602-242-5828
Mailing Address - Fax:
Practice Address - Street 1:15338 W POINSETTIA DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5282
Practice Address - Country:US
Practice Address - Phone:602-242-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool