Provider Demographics
NPI:1376733980
Name:WOOD, ROSANNA M (LCPC)
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:M
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 584
Mailing Address - Street 2:2695 SILER CITY-GLENDON ROAD
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-0584
Mailing Address - Country:US
Mailing Address - Phone:919-810-0770
Mailing Address - Fax:919-742-4131
Practice Address - Street 1:2695 SILER CITY GLENDON RD
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-0584
Practice Address - Country:US
Practice Address - Phone:919-810-0770
Practice Address - Fax:919-742-4131
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1289101YM0800X
NC6850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6850OtherSTATE OF NORTH CAROLINA BOARD OF LICENSED PROFESSIONAL COUNSELORS
MT1289OtherSTATE OF MONTANA LICENSE
NC6103810Medicaid