Provider Demographics
NPI:1821203126
Name:WOODHOUSE, DEIRDRE KAY (PHD)
Entity type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:KAY
Last Name:WOODHOUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DEEDEE
Other - Middle Name:
Other - Last Name:WOODHOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:520 DELBURG ST
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-6948
Mailing Address - Country:US
Mailing Address - Phone:704-455-2014
Mailing Address - Fax:
Practice Address - Street 1:212 S MAIN ST STE 317
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8039
Practice Address - Country:US
Practice Address - Phone:704-455-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC292157000OtherMAGELLAN
NC6000485Medicaid