Healthcare Provider Details

I. General information

NPI: 1184393886
Provider Name (Legal Business Name): DANIELLE P WOODRUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 THE EXCHANGE SE STE 100
ATLANTA GA
30339-2022
US

IV. Provider business mailing address

5150 THOMPSON RD APT 9001
FAIRBURN GA
30213-7744
US

V. Phone/Fax

Practice location:
  • Phone: 404-233-3949
  • Fax:
Mailing address:
  • Phone: 404-587-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: