Provider Demographics
NPI:1750359683
Name:WOODS, TAMARA NICHOLE (LPC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:NICHOLE
Last Name:WOODS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:NICHOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:62 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1349
Mailing Address - Country:US
Mailing Address - Phone:678-423-1066
Mailing Address - Fax:
Practice Address - Street 1:770 GREISON TRL
Practice Address - Street 2:SUITE A
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6408
Practice Address - Country:US
Practice Address - Phone:770-683-9096
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004349101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor