Provider Demographics
NPI:1336259316
Name:WOODWORTH, KATHERINE G (LPC, CRC, DCC,CCPD-D)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:G
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:LPC, CRC, DCC,CCPD-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#8 SHACKLEFORD PLAZA, STE 209
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211
Mailing Address - Country:US
Mailing Address - Phone:501-326-4437
Mailing Address - Fax:866-228-4191
Practice Address - Street 1:518 S EAST ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4318
Practice Address - Country:US
Practice Address - Phone:501-438-0807
Practice Address - Fax:866-545-5491
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0811083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional