Provider Demographics
NPI:1316234990
Name:WOODY, REBECCA IRENE (LPCC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:IRENE
Last Name:WOODY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 MESA BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-3038
Mailing Address - Country:US
Mailing Address - Phone:505-287-3773
Mailing Address - Fax:505-287-5011
Practice Address - Street 1:1109 MESA BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-3038
Practice Address - Country:US
Practice Address - Phone:505-287-3773
Practice Address - Fax:505-287-5011
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0116971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health