Provider Demographics
NPI:1154749000
Name:WOODLAND, TERRY (MBA, CDP)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:WOODLAND
Suffix:
Gender:F
Credentials:MBA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 SW 10TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2981
Mailing Address - Country:US
Mailing Address - Phone:425-336-4708
Mailing Address - Fax:425-336-2808
Practice Address - Street 1:451 SW 10TH ST STE 100
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2981
Practice Address - Country:US
Practice Address - Phone:425-336-4708
Practice Address - Fax:425-336-2808
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60384393101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)