Healthcare Provider Details

I. General information

NPI: 1952811382
Provider Name (Legal Business Name): KORRESHIA WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 BUCKEYE ST
HAMILTON OH
45011-3452
US

IV. Provider business mailing address

515 DAYTON ST
HAMILTON OH
45011-3455
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-7654
  • Fax:
Mailing address:
  • Phone: 513-868-7654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCII.161513
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.110239
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: