Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | SW861086 | LA |
NPI | 1124609011 |
---|---|
Provider Name | Stacey Alanna Woods |
First Address | Baton Rouge, LA 70810-6415 |
Second Address | Baton Rouge, LA 70810-6415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2021 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SW861086 | PRIVATE PRACTICE (01) | LA |