Provider Demographics
NPI:1164983276
Name:ORTIZ, EMILY WOODS (MA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:WOODS
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 PLANTATION TRL
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-7948
Mailing Address - Country:US
Mailing Address - Phone:704-689-9879
Mailing Address - Fax:
Practice Address - Street 1:973 PLANTATION TRAIL
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056
Practice Address - Country:US
Practice Address - Phone:704-689-9879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2024-09-27
Deactivation Date:2019-03-29
Deactivation Code:
Reactivation Date:2019-04-18
Provider Licenses
StateLicense IDTaxonomies
NCA18521101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health