Provider Demographics
NPI:1962949735
Name:WOODALL, ELIZABETH CHEYENNE (CSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHEYENNE
Last Name:WOODALL
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CHEYENNE
Other - Last Name:HENSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2008
Mailing Address - Country:US
Mailing Address - Phone:859-885-6315
Mailing Address - Fax:
Practice Address - Street 1:324 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2008
Practice Address - Country:US
Practice Address - Phone:859-885-6315
Practice Address - Fax:859-887-1886
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2591101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical