Provider Demographics
NPI:1447024682
Name:WOODS, JEFFREY MARK (BA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:WOODS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 BRODERICK DR
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1753
Mailing Address - Country:US
Mailing Address - Phone:202-374-0006
Mailing Address - Fax:
Practice Address - Street 1:709 BRODERICK DR
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1753
Practice Address - Country:US
Practice Address - Phone:202-374-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health