Provider Demographics
NPI:1861266447
Name:WOODALL, COLLEEN CATHERINE (LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:CATHERINE
Last Name:WOODALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6927 QUIET COVE DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-3728
Mailing Address - Country:US
Mailing Address - Phone:704-519-9422
Mailing Address - Fax:
Practice Address - Street 1:6927 QUIET COVE DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-3728
Practice Address - Country:US
Practice Address - Phone:704-519-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1180851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical