Provider Demographics
NPI:1235990375
Name:WOOD, WESLEY (MA, ADC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:MA, ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 MACCORKLE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2074
Mailing Address - Country:US
Mailing Address - Phone:304-419-7252
Mailing Address - Fax:
Practice Address - Street 1:2333 MACCORKLE AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2074
Practice Address - Country:US
Practice Address - Phone:304-419-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23-114101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)