Basic Information
| Provider Information | |||||||||
| NPI: | 1073004776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODS | ||||||||
| FirstName: | MARSHA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67925 BAYBERRY DRIVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ST. CLAIRSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405260204 | ||||||||
| FaxNumber: | 7405260207 | ||||||||
| Practice Location | |||||||||
| Address1: | 67925 BAYBERRY DRIVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ST. CLAIRSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405260204 | ||||||||
| FaxNumber: | 7405260207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2018 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1701484 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | I.2002253 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.