Provider Demographics
NPI:1104452333
Name:WOODRUFF, PATRICK TRAVIS (MA, LCMHC, LCAS, CSI)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:TRAVIS
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:MA, LCMHC, LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246A S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4551
Mailing Address - Country:US
Mailing Address - Phone:828-237-3438
Mailing Address - Fax:
Practice Address - Street 1:246A S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4551
Practice Address - Country:US
Practice Address - Phone:252-559-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25275101YA0400X
NCA14792101YM0800X
NC14792101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional