Provider Demographics
NPI:1578634564
Name:WOOD, CAROLYN INGALLS (LCSWC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:INGALLS
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:376 LOBLOLLY WAY
Mailing Address - Street 2:
Mailing Address - City:GRASONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21638-1031
Mailing Address - Country:US
Mailing Address - Phone:301-758-4939
Mailing Address - Fax:
Practice Address - Street 1:14440 CHERRY LANE CT
Practice Address - Street 2:SUITE 216
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4946
Practice Address - Country:US
Practice Address - Phone:301-758-4939
Practice Address - Fax:410-304-2511
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD095271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD520574Medicare PIN