Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 792 | SC |
N | 103TC0700X | Clinical Psychologist | 792 | SC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 792 | SC |
Y | 103G00000X | Clinical Psychologist | 792 | SC |
Y | 103TC0700X | Clinical Psychologist | 792 | SC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 792 | SC |
N | 103TF0000X | Family Psychologist | 792 | SC |
NPI | 1215989967 |
---|---|
Provider Name | George Raymond Woodruff |
First Address | Anderson, SC 29621-3620 |
Second Address | Anderson, SC 29621-3620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 24/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PS0317 | (05) | SC |