Provider Demographics
NPI:1982229167
Name:WOODRUFF, JAIME (LPCA)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 NORTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-5339
Mailing Address - Country:US
Mailing Address - Phone:864-420-6434
Mailing Address - Fax:
Practice Address - Street 1:7 PETTIGRU ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3028
Practice Address - Country:US
Practice Address - Phone:864-235-7501
Practice Address - Fax:864-235-7503
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
SC10367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician