Provider Demographics
NPI:1982957882
Name:WOODALL, EVAN-MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:EVAN-MARIE
Middle Name:
Last Name:WOODALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 HORIZON RD STE C
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-2081
Mailing Address - Country:US
Mailing Address - Phone:972-734-1985
Mailing Address - Fax:469-565-1274
Practice Address - Street 1:6730 HORIZON RD STE C
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-2081
Practice Address - Country:US
Practice Address - Phone:972-734-1985
Practice Address - Fax:469-565-1274
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67483101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional