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General NPI Number Information
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NPI Number | 1104452333
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Entity Type | Individual
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Provider Name | PATRICK TRAVIS WOODRUFF MA, LCMHC, LCAS, CSI
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Gender | Male
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 246A S MAIN ST
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City | MARION
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State | NC
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Zip | 28752-4551
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Country | US
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Telephone | 252-559-2882
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Fax |
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Provider Business Mailing Address
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Address Line | 246A S MAIN ST
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City | MARION
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State | NC
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Zip | 28752-4551
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Country | US
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Telephone | 828-237-3438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 25275
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A14792
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14792
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 14792
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License Number State | NC
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