Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0813000403 | VA |
NPI | 1033623756 |
---|---|
Provider Name | Priscilla Woodson |
First Address | Roanoke, VA 24018-4016 |
Second Address | Rocky Mount, VA 24151-6614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2017 |
Last Update Date | 17/11/2017 |