Provider Demographics
NPI:1073297834
Name:WOOD, EDISON (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:EDISON
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4137
Mailing Address - Country:US
Mailing Address - Phone:919-443-5334
Mailing Address - Fax:
Practice Address - Street 1:1921 NORTH POINTE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2672
Practice Address - Country:US
Practice Address - Phone:919-443-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0190741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical