Provider Demographics
NPI:1609103951
Name:WOOD, JESSICA ALICE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALICE
Last Name:WOOD
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 E ARLINGTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5931
Mailing Address - Country:US
Mailing Address - Phone:252-321-6306
Mailing Address - Fax:252-355-3689
Practice Address - Street 1:1310 E ARLINGTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5931
Practice Address - Country:US
Practice Address - Phone:252-321-6306
Practice Address - Fax:252-355-3689
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1350106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist