Provider Demographics
NPI:1063582385
Name:WOODRUFF, DIANA L (PHD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 SOUTH BERKELEY LAKE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071
Mailing Address - Country:US
Mailing Address - Phone:770-446-5642
Mailing Address - Fax:770-446-5643
Practice Address - Street 1:4530 SOUTH BERKELEY LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:770-446-5642
Practice Address - Fax:770-446-5643
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional