Healthcare Provider Details

I. General information

NPI: 1275907180
Provider Name (Legal Business Name): ANDREW M WOODS LCMHC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 YOUPON ST
OCEAN SPRINGS MS
39564-5221
US

IV. Provider business mailing address

2607 YOUPON ST
OCEAN SPRINGS MS
39564-5221
US

V. Phone/Fax

Practice location:
  • Phone: 704-974-0140
  • Fax:
Mailing address:
  • Phone: 704-974-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11886
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: