Provider Demographics
NPI:1669849881
Name:WOODWARD, TARA DANIELLE (LPC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:DANIELLE
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:DANIELLE
Other - Last Name:WIDAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:5258 BREEZE HILL PL
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2721
Mailing Address - Country:US
Mailing Address - Phone:248-835-2445
Mailing Address - Fax:
Practice Address - Street 1:5258 BREEZE HILL PL
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2721
Practice Address - Country:US
Practice Address - Phone:248-835-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional