1255429650 NPI number — MS. ELIZABETH MICHELLE WOODS LMSW

Table of content: MS. ELIZABETH MICHELLE WOODS LMSW (NPI 1255429650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255429650 NPI number — MS. ELIZABETH MICHELLE WOODS LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
ELIZABETH
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255429650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2087
Provider Second Line Business Mailing Address:
141 SUNSET LOOP
Provider Business Mailing Address City Name:
GRENADA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38902-2087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-307-2584
Provider Business Mailing Address Fax Number:
662-307-2666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 SUNSET LOOP
Provider Second Line Business Practice Location Address:
AGAPE ADULT DAY SERVICES AND RECREATIONAL CENTER, LLC
Provider Business Practice Location Address City Name:
GRENADA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38901-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-307-2584
Provider Business Practice Location Address Fax Number:
662-307-2666
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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