Provider Demographics
NPI:1932975158
Name:LEGETTE, WOODICA
Entity Type:Individual
Prefix:
First Name:WOODICA
Middle Name:
Last Name:LEGETTE
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 1:200 JADETREE DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-9347
Mailing Address - Country:US
Mailing Address - Phone:803-397-7375
Mailing Address - Fax:
Practice Address - Street 1:200 JADETREE DR
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:SC
Practice Address - Zip Code:29061-9347
Practice Address - Country:US
Practice Address - Phone:803-397-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician