Individual
THEODORE ROY WOODRUFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
400 VIRGINIA AVE, NORTH BEND, OR 97459-3477
(541) 751-0357
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 672-2691
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
14-CRM-024
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-20-391
OR
175T00000X
Peer Specialist
THW000000864
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14-CRM-024
MHACBO CRM
OR
05
—
500609571
—
OR
Enumeration date
09/20/2017
Last updated
03/04/2026
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