Provider Demographics
NPI:1578132049
Name:WOOD, NICOLE (CDCA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18003 WOODSFIELD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-1392
Mailing Address - Country:US
Mailing Address - Phone:740-732-5988
Mailing Address - Fax:
Practice Address - Street 1:18003 WOODSFIELD RD STE 2
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-1392
Practice Address - Country:US
Practice Address - Phone:740-732-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND171M00000X171M00000X
OHCDCA.177066101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator