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General NPI Number Information
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NPI Number | 1306986401
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Entity Type | Individual
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Provider Name | MARY JANE WOOLDRIDGE LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 700 SOUTHRIDGE PKWY SUITE 301
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City | CULPEPER
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State | VA
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Zip | 22701-3723
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Country | US
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Telephone | 540-829-2393
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Fax |
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Provider Business Mailing Address
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Address Line | 215 TURKEY RIDGE ROAD
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City | BOSTON
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State | VA
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Zip | 22713-1802
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Country | US
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Telephone | 540-829-2393
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0904003463
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License Number State | VA
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