MEDICARE: VALERIE WOODSON

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	101YM0800X	Mental Health Counselor	IMH19244	FL
2	222Q00000X	Developmental Therapist
3	376J00000X	Homemaker
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
5	174200000X	Meals Provider
6	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1578000360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE WOODSON

Provider Business Mailing Address
First Line	:	2737 BRYCE RAVINE AVE
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33565-5998
Country	:	US
Telephone Number	:	813-951-5468
Fax Number	:

Provider Business Practice Location Address
First Line	:	6917 N 53RD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-8703
Country	:	US
Telephone Number	:	813-951-5468
Fax Number	:

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

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	04/06/2026

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