Healthcare Provider Details

I. General information

NPI: 1376255265
Provider Name (Legal Business Name): MISTY LEE WOODARD RBA, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 09/29/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENTON DR STE 200
CHARLESTON WV
25311-1256
US

IV. Provider business mailing address

1005 WHITE WILLOW WAY
MORGANTOWN WV
26505-6119
US

V. Phone/Fax

Practice location:
  • Phone: 304-513-3495
  • Fax:
Mailing address:
  • Phone: 304-513-3495
  • Fax: 800-734-8498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00946585
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: