Provider Demographics
NPI:1487613204
Name:WOODDELL, VALECIA LISA
Entity type:Individual
Prefix:MS
First Name:VALECIA
Middle Name:LISA
Last Name:WOODDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:LEFLET
Other - Last Name:WOODDELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1385
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-1385
Mailing Address - Country:US
Mailing Address - Phone:252-209-8161
Mailing Address - Fax:252-209-6011
Practice Address - Street 1:1112 ACADEMY ST N
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-2210
Practice Address - Country:US
Practice Address - Phone:252-209-8161
Practice Address - Fax:252-209-6011
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0035491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE0075OtherMEDCOST
NC12779OtherBCBS OF NC
NC6003004Medicaid
NC6003004Medicaid
NC12779OtherBCBS OF NC