Healthcare Provider Details

I. General information

NPI: 1013951268
Provider Name (Legal Business Name): WOODRIDGE PSYCHOLOGICAL ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 W COURT ST
RUTHERFORDTON NC
28139
US

IV. Provider business mailing address

PO BOX 878
RUTHERFORDTON NC
28139
US

V. Phone/Fax

Practice location:
  • Phone: 828-287-7806
  • Fax: 828-287-0004
Mailing address:
  • Phone: 828-287-7806
  • Fax: 828-287-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TERRY LEE LEDFORD
Title or Position: PRESIDENT
Credential: PHD
Phone: 828-287-7806