Provider Demographics
NPI:1265642763
Name:WOOD, CHRISTOPHER (MA CADC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:MA CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 BLANKENBAKER PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1845
Mailing Address - Country:US
Mailing Address - Phone:502-253-8425
Mailing Address - Fax:502-253-8433
Practice Address - Street 1:920 BLANKENBAKER PARKWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1845
Practice Address - Country:US
Practice Address - Phone:502-253-8425
Practice Address - Fax:502-253-8433
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
KYKY-0620101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor