Provider Demographics
NPI:1386034239
Name:WOOD, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3430
Mailing Address - Country:US
Mailing Address - Phone:517-862-2197
Mailing Address - Fax:
Practice Address - Street 1:2025 S WASHINGTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0828
Practice Address - Country:US
Practice Address - Phone:517-371-1111
Practice Address - Fax:517-371-1121
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801095863101YA0400X
MI13860342391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)