Provider Demographics
NPI:1598839581
Name:WOOD, KEISHA D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:D
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCSW
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 352
Mailing Address - Street 2:
Mailing Address - City:GUY
Mailing Address - State:AR
Mailing Address - Zip Code:72061-0352
Mailing Address - Country:US
Mailing Address - Phone:870-899-0884
Mailing Address - Fax:
Practice Address - Street 1:1813 EXECUTIVE SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6086
Practice Address - Country:US
Practice Address - Phone:870-899-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2154-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical