Individual
CHAQUITA WOODBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9705 NE 3RD ST, MIDWEST CITY, OK 73130-3511
(405) 532-9843
Mailing address
9705 NE 3RD ST, MIDWEST CITY, OK 73130-3511
(405) 532-9843
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
K081534729
OK
101YM0800X
Mental Health Counselor
K081534729
OK
Other
Enumeration date
10/21/2016
Last updated
10/21/2016
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