Provider Demographics
NPI:1194809855
Name:WOODS, WENDIE WREN (LPC)
Entity type:Individual
Prefix:MS
First Name:WENDIE
Middle Name:WREN
Last Name:WOODS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3157
Mailing Address - Country:US
Mailing Address - Phone:662-617-2686
Mailing Address - Fax:662-338-1880
Practice Address - Street 1:309 E LAMPKIN ST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2909
Practice Address - Country:US
Practice Address - Phone:662-338-1880
Practice Address - Fax:662-338-1880
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS696101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS$$$$$$$$$COtherBCBSMS