Provider Demographics
NPI:1780464545
Name:WOODWARD, ROXANNE MARIE
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:MARIE
Last Name:WOODWARD
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 1:3094 CHARLES TOWN RD
Mailing Address - Street 2:
Mailing Address - City:KEARNEYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25430-2669
Mailing Address - Country:US
Mailing Address - Phone:703-986-7125
Mailing Address - Fax:
Practice Address - Street 1:3094 MOUNTAINEER BEHAVIORAL HEALTH
Practice Address - Street 2:
Practice Address - City:KEARNEYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25430
Practice Address - Country:US
Practice Address - Phone:703-986-7125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009466681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical