Healthcare Provider Details

I. General information

NPI: 1255579488
Provider Name (Legal Business Name): BARBARA SPECKHARD WOODS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1797 OLD MOULTRIE RD STE 112
ST AUGUSTINE FL
32084-5798
US

IV. Provider business mailing address

4000 STATE ROAD 16
ST AUGUSTINE FL
32092-0731
US

V. Phone/Fax

Practice location:
  • Phone: 904-607-8899
  • Fax:
Mailing address:
  • Phone: 904-607-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: