Basic Information
| Provider Information | |||||||||
| NPI: | 1023066826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODARD | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5812 MAYBROOK CT | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230596946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043642819 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19254 ROGERS CLARK BLVD | ||||||||
| Address2: | |||||||||
| City: | RUTHER GLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225464010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8046339997 | ||||||||
| FaxNumber: | 8046337031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 08/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904004439 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 004945123 | 05 | VA | MEDICAID | 0006359 | 01 | VA | TRICARE | OTHER | 287193 | 01 | VA | ANTHEM | OTHER | 291352 | 01 | VA | MDIPA | OTHER | 089857 | 01 | VA | SENTARA | OTHER |