Provider Demographics
NPI:1073806949
Name:WOOD, IRENE (LPC)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COASTAL VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2878
Mailing Address - Country:US
Mailing Address - Phone:912-554-8510
Mailing Address - Fax:
Practice Address - Street 1:415 BONAVENTURE RD
Practice Address - Street 2:
Practice Address - City:THUNDERBOLT
Practice Address - State:GA
Practice Address - Zip Code:31404-3299
Practice Address - Country:US
Practice Address - Phone:912-790-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional