MEDICARE: DAVID WOODEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1073122719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID WOODEN

Provider Business Mailing Address
First Line	:	905 GILBERT ST
Second Line	:
City	:	RADFORD
State	:	VA
Zip	:	24141-3110
Country	:	US
Telephone Number	:	540-505-2490
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 WILSON BLVD # 300
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-4417
Country	:	US
Telephone Number	:	703-829-6394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	07/29/2020

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Directions to “ DAVID WOODEN ” Practice Location

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