Provider Demographics
NPI:1386458214
Name:WOOLDRIDGE, MIA ALPHONSA (MS, M ED)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:ALPHONSA
Last Name:WOOLDRIDGE
Suffix:
Gender:
Credentials:MS, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5461 NILES RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4917
Mailing Address - Country:US
Mailing Address - Phone:804-856-0593
Mailing Address - Fax:
Practice Address - Street 1:5461 NILES RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-4917
Practice Address - Country:US
Practice Address - Phone:804-856-0593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health