Basic Information
| Provider Information | |||||||||
| NPI: | 1962475517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODY | ||||||||
| FirstName: | SHARLYN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1820 CENTRAL AVENUE SUITE B & C | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016205130 | ||||||||
| FaxNumber: | 5016205109 | ||||||||
| Practice Location | |||||||||
| Address1: | 1820 CENTRAL AVENUE SUITE C & D | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016236000 | ||||||||
| FaxNumber: | 5016236004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 2587-C | AR | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 1443-M | AR | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 116399726 | 05 | AR | MEDICAID | 219546 | 01 | AR | COMPSYCH | OTHER | 288004 | 01 | AR | MHN NETWORK | OTHER |