Provider Demographics
NPI:1891571956
Name:WOODEN, ALEXIS JULIANN
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JULIANN
Last Name:WOODEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 FORD RD
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1408
Mailing Address - Country:US
Mailing Address - Phone:607-725-8988
Mailing Address - Fax:
Practice Address - Street 1:9846 LORI RD # 210
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6695
Practice Address - Country:US
Practice Address - Phone:607-725-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional