Provider Demographics
NPI:1598063315
Name:WOOD, ANGELA R (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:R
Last Name:WOOD
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42120 N ELMWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1344
Mailing Address - Country:US
Mailing Address - Phone:985-320-7623
Mailing Address - Fax:
Practice Address - Street 1:42120 N ELMWOOD LOOP
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1344
Practice Address - Country:US
Practice Address - Phone:985-320-7623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48001041C0700X
LA784106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist