Basic Information
| Provider Information | |||||||||
| NPI: | 1679947352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODS | ||||||||
| FirstName: | GINGER | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 W JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325057552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504364630 | ||||||||
| FaxNumber: | 8504362095 | ||||||||
| Practice Location | |||||||||
| Address1: | 5868 CREEK STATION DR BLDG A | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504781244 | ||||||||
| FaxNumber: | 8504781894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2015 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW 12544 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 020065200 | 05 | FL | MEDICAID | KX914 | 01 | FL | MCR | OTHER | 13656075 | 01 | CAQH | OTHER | NXDFC | 01 | FL | BCBS | OTHER |