Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC004390 | GA |
NPI | 1003050840 |
---|---|
Provider Name | Mrs. Carolyn Woodard |
First Address | Macon, GA 31201-2677 |
Second Address | Macon, GA 31201-2677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2009 |
Last Update Date | 23/04/2009 |