Provider Demographics
NPI:1881890952
Name:WOODSON, LAWRENCE EUGENE (ED D)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:EUGENE
Last Name:WOODSON
Suffix:
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E FRANKLIN ST
Mailing Address - Street 2:SUITE 724
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2322
Mailing Address - Country:US
Mailing Address - Phone:804-521-4050
Mailing Address - Fax:804-521-4048
Practice Address - Street 1:501 E FRANKLIN ST
Practice Address - Street 2:SUITE 724
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2322
Practice Address - Country:US
Practice Address - Phone:804-521-4050
Practice Address - Fax:804-521-4048
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710-1135-8350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA94205001Medicaid