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General NPI Number Information
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NPI Number | 1609402957
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Entity Type | Individual
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Provider Name | BRIAN WOODSIDE CIP, ICRC-ADC, CAC,
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Gender | Male
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 915 SWEETGRASS ST
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-6127
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Country | US
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Telephone | 561-376-6685
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Fax |
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Provider Business Mailing Address
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Address Line | 915 SWEETGRASS ST
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-6127
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Country | US
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Telephone | 561-376-6685
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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 | CAC100072
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CET100015
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CRSS100026
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | I0181
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 806449
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License Number State | FL
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