Provider Demographics
NPI:1164919825
Name:WOOD, DEBORAH (LPC, RN, NCC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPC, RN, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 VANGUARD DR STE 250
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4707
Mailing Address - Country:US
Mailing Address - Phone:807-683-6855
Mailing Address - Fax:
Practice Address - Street 1:8101 VANGUARD DR STE 250
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4707
Practice Address - Country:US
Practice Address - Phone:807-683-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007602101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty