Provider Demographics
NPI:1538574280
Name:WOODALL, DANIEL FRANKLIN (BA PSR BST)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:FRANKLIN
Last Name:WOODALL
Suffix:
Gender:M
Credentials:BA PSR BST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 W COLLEGE PKWY
Mailing Address - Street 2:APT 38
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-7453
Mailing Address - Country:US
Mailing Address - Phone:503-791-8195
Mailing Address - Fax:
Practice Address - Street 1:2094 W COLLEGE PKWY
Practice Address - Street 2:APT 38
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-7453
Practice Address - Country:US
Practice Address - Phone:503-791-8195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health