Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1437678224 |
---|---|
Provider Name | Paige Dyer Woodard |
First Address | Stockton, CA 95205-4232 |
Second Address | San Andreas, CA 95249-9642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2017 |
Last Update Date | 13/09/2017 |