Healthcare Provider Details

I. General information

NPI: 1134857741
Provider Name (Legal Business Name): ANDREW LEO WOODCOX LMSW-CLINICAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VISTA DR
COLDWATER MI
49036-1776
US

IV. Provider business mailing address

200 VISTA DR
COLDWATER MI
49036-1776
US

V. Phone/Fax

Practice location:
  • Phone: 517-278-2129
  • Fax: 517-279-8172
Mailing address:
  • Phone: 517-278-2129
  • Fax: 517-279-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801115739
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: