Provider Demographics
NPI:1548704869
Name:WOODALL, CHARITY (ND)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:WOODALL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221A CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-1417
Mailing Address - Country:US
Mailing Address - Phone:832-788-6641
Mailing Address - Fax:
Practice Address - Street 1:6 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1647
Practice Address - Country:US
Practice Address - Phone:508-414-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60661084175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath