Healthcare Provider Details

I. General information

NPI: 1992615264
Provider Name (Legal Business Name): EVITA WOODS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 BROOKHAVEN CIR
BLYTHEWOOD SC
29016-8942
US

IV. Provider business mailing address

108 BROOKHAVEN CIR
BLYTHEWOOD SC
29016-8942
US

V. Phone/Fax

Practice location:
  • Phone: 803-979-6257
  • Fax:
Mailing address:
  • Phone: 803-979-6257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7628
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: