Healthcare Provider Details

I. General information

NPI: 1558571281
Provider Name (Legal Business Name): VICTORIA WOODWARD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E BROAD ST
HAZLETON PA
18201-6835
US

IV. Provider business mailing address

PO BOX 95
SAINT JOHNS PA
18247-0095
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-6385
  • Fax: 570-579-0355
Mailing address:
  • Phone: 570-455-6385
  • Fax: 570-579-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC001388
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPC001388
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerLPC LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: