Healthcare Provider Details

I. General information

NPI: 1760309231
Provider Name (Legal Business Name): JAMES MELVIN WOODARD LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8229 WYSONG DR
INDIANAPOLIS IN
46219-1836
US

IV. Provider business mailing address

8229 WYSONG DR
INDIANAPOLIS IN
46219-1836
US

V. Phone/Fax

Practice location:
  • Phone: 317-610-1999
  • Fax:
Mailing address:
  • Phone: 317-610-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number86000466A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: