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1376255265 NPI number — MISTY LEE WOODARD RBA, MSW

NPI Number: 1376255265
Health Care Provider/Practitioner: MISTY LEE WOODARD RBA, MSW

Information about “1376255265” NPI (MISTY LEE WOODARD RBA, MSW) exists in 1376255265 in HTML format HTML  |  1376255265 in plain Text format TXT  |  1376255265 in PDF (Portable Document Format) PDF  |  1376255265 in an XML format XML  formats.

NPI Number : 1376255265 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376255265",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WOODARD",
    "FirstName": "MISTY",
    "MiddleName": "LEE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "RBA, MSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "101 MARTIN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOUNT HOPE",
    "MailingAddressStateName": "WV",
    "MailingAddressPostalCode": "25880-1509",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "681-422-3338",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1 KENTON DR STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLESTON",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "25311-1256",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-513-3495",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/22/2022",
    "LastUpdateDate": "04/10/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "BP00946585",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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