Provider Demographics
NPI:1619466117
Name:WOOD, BRITTANEY N
Entity Type:Individual
Prefix:
First Name:BRITTANEY
Middle Name:N
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 TIDEWATER COLONY DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2111
Mailing Address - Country:US
Mailing Address - Phone:410-441-3489
Mailing Address - Fax:
Practice Address - Street 1:2009 TIDEWATER COLONY DR STE 2A
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2111
Practice Address - Country:US
Practice Address - Phone:410-441-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 156F00000X
MI156F00000X
MDLGP13632101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist