MEDICARE: DEEDRA D WOODS LCSW

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	1041C0700X	Clinical Social Worker	22681	FL

General Provider Information

NPI Number	:	1184140071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEDRA D WOODS LCSW

Provider Business Mailing Address
First Line	:	6501 ARLINGTON EXPY STE 109
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5779
Country	:	US
Telephone Number	:	904-208-0760
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 ARLINGTON EXPY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5779
Country	:	US
Telephone Number	:	904-208-0760
Fax Number	:

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

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	04/09/2024

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