MEDICARE: MR. ZACHARY WOODBY LMSW CAADC

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	6801098340	MI

General Provider Information

NPI Number	:	1356780035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ZACHARY WOODBY LMSW CAADC

Provider Business Mailing Address
First Line	:	42815 GARFIELD RD STE 210
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1143
Country	:	US
Telephone Number	:	586-846-4835
Fax Number	:	586-408-6485

Provider Business Practice Location Address
First Line	:	42815 GARFIELD RD STE 210
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1143
Country	:	US
Telephone Number	:	586-846-4835
Fax Number	:	586-408-6485

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

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	05/06/2019

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