Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 012695 | NY |
N | 103TC0700X | Clinical Psychologist | 012695 | NY |
Y | 103G00000X | Clinical Psychologist | 3635 | NC |
Y | 103TC0700X | Clinical Psychologist | 3635 | NC |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 012695 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3635 | NC |
N | 103TA0700X | Adult Development & Aging Psychologist | 012695 | NY |
N | 103TA0700X | Adult Development & Aging Psychologist | 3635 | NC |
N | 103G00000X | Clinical Psychologist | 012695 | NY |
N | 103TC0700X | Clinical Psychologist | 012695 | NY |
N | 103G00000X | Clinical Psychologist | 3635 | NC |
N | 103TC0700X | Clinical Psychologist | 3635 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 012695 | NY |
N | 103TF0200X | Forensic Psychologist | 012695 | NY |
N | 103TF0200X | Forensic Psychologist | 3635 | NC |
N | 103TP0814X | Psychoanalysis | 3635 | NC |
NPI | 1881749539 |
---|---|
Provider Name | Dr. G. Martin Woodard |
First Address | Fayetteville, NC 28303-5504 |
Second Address | Fayetteville, NC 28303-5504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 18/07/2011 |