Healthcare Provider Details

I. General information

NPI: 1588597629
Provider Name (Legal Business Name): DARNELL WOODSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 AUDUBON RD BLDG 1
WAKEFIELD MA
01880-1266
US

IV. Provider business mailing address

177 E COLORADO BLVD STE 200
PASADENA CA
91105-1955
US

V. Phone/Fax

Practice location:
  • Phone: 844-669-7827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: