Provider Demographics
NPI:1073203147
Name:WOOD, EMMA KAY (RBT)
Entity Type:Individual
Prefix:MS
First Name:EMMA
Middle Name:KAY
Last Name:WOOD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 MOUNTAIN CREEK RD APT 14A7
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-7250
Mailing Address - Country:US
Mailing Address - Phone:423-394-3284
Mailing Address - Fax:
Practice Address - Street 1:1961 NORTHPOINT BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4999
Practice Address - Country:US
Practice Address - Phone:423-498-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-22-207711106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician