Healthcare Provider Details

I. General information

NPI: 1528677739
Provider Name (Legal Business Name): MICHAEL DUSTIN WOODARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 RANSOM PL
NASHVILLE TN
37217-3841
US

IV. Provider business mailing address

1078 S WATER AVE
GALLATIN TN
37066-3959
US

V. Phone/Fax

Practice location:
  • Phone: 615-279-6700
  • Fax:
Mailing address:
  • Phone: 615-230-9663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5151
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: