Provider Demographics
NPI:1083916357
Name:WOOD, ALTON WAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALTON
Middle Name:WAYNE
Last Name:WOOD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9008 ELK GROVE BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1945
Mailing Address - Country:US
Mailing Address - Phone:916-709-1648
Mailing Address - Fax:
Practice Address - Street 1:9008 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1945
Practice Address - Country:US
Practice Address - Phone:916-709-1648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27856101Y00000X
CA752831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor