Provider Demographics
NPI:1730614496
Name:WOODBURY, WILLIAM (CADC II)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:WOODBURY
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-3809
Mailing Address - Country:US
Mailing Address - Phone:562-221-2860
Mailing Address - Fax:
Practice Address - Street 1:6321 CORONADO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-3809
Practice Address - Country:US
Practice Address - Phone:562-221-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator