Provider Demographics
NPI:1952790875
Name:WOODRUFF, LATRICE YVETTE
Entity Type:Individual
Prefix:MRS
First Name:LATRICE
Middle Name:YVETTE
Last Name:WOODRUFF
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 1:750 SPAANS DR STE CDF
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-8609
Mailing Address - Country:US
Mailing Address - Phone:209-451-3628
Mailing Address - Fax:209-932-9446
Practice Address - Street 1:445 W WEBER AVE
Practice Address - Street 2:SUITE 30
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-3151
Practice Address - Country:US
Practice Address - Phone:209-451-3628
Practice Address - Fax:209-932-9446
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)