Provider Demographics
NPI:1790040806
Name:WOODS, SHETRESS LADAWN (MA)
Entity type:Individual
Prefix:MS
First Name:SHETRESS
Middle Name:LADAWN
Last Name:WOODS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 CHARDONNAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5135
Mailing Address - Country:US
Mailing Address - Phone:321-960-4642
Mailing Address - Fax:
Practice Address - Street 1:190 MCIVER LN
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5412
Practice Address - Country:US
Practice Address - Phone:321-631-8569
Practice Address - Fax:321-631-6530
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health