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General NPI Number Information
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NPI Number | 1629588769
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Entity Type | Organization
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Legal Business Name | KAREN WOODHOUSE, LLC
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 919 W 21ST ST STE B
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City | NORFOLK
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State | VA
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Zip | 23517-1559
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Country | US
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Telephone | 757-622-6794
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WILLOW WOOD DR APT A5
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City | NORFOLK
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State | VA
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Zip | 23505-4830
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Country | US
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Telephone | 757-544-4427
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | KAREN ANNE WOODHOUSE
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Credential | LCSW
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Telephone | 757-544-4427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 0904006013
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License Number State | VA
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