Healthcare Provider Details

I. General information

NPI: 1396174702
Provider Name (Legal Business Name): DARREN TODD WOODLIEF PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 BULL ST
COLUMBIA SC
29201-2506
US

IV. Provider business mailing address

1816 BULL ST
COLUMBIA SC
29201-2506
US

V. Phone/Fax

Practice location:
  • Phone: 803-422-0017
  • Fax: 803-799-5596
Mailing address:
  • Phone: 803-422-0017
  • Fax: 803-799-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1534
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: