Provider Demographics
NPI:1639853609
Name:WOOD, AMY (LLMSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAFAYETTE PLAISANCE ST APT 1906
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2868
Mailing Address - Country:US
Mailing Address - Phone:616-540-8259
Mailing Address - Fax:
Practice Address - Street 1:3303 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1101
Practice Address - Country:US
Practice Address - Phone:313-389-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511101881041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool