Healthcare Provider Details

I. General information

NPI: 1629410907
Provider Name (Legal Business Name): DARLEEN CLAIRE WODZENSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 CHARLESTOWN DR
COLLEGE PARK GA
30337-3909
US

IV. Provider business mailing address

231 BENTONVILLE LN
DOUGLASVILLE GA
30134-6301
US

V. Phone/Fax

Practice location:
  • Phone: 770-686-0894
  • Fax: 877-660-8884
Mailing address:
  • Phone: 770-686-0894
  • Fax: 877-350-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC011101
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT002427
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: