Provider Demographics
NPI:1376168120
Name:WOOD, SHEA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SHEA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SUGARLOAF LOOP
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6369
Mailing Address - Country:US
Mailing Address - Phone:501-913-1260
Mailing Address - Fax:
Practice Address - Street 1:8 SHACKLEFORD PLZ STE 206
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1853
Practice Address - Country:US
Practice Address - Phone:501-913-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2005070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health