Provider Demographics
NPI:1679646285
Name:WOOD, CAROL JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JOAN
Last Name:WOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PIIKOI
Mailing Address - Street 2:SUIT 1409
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-596-8038
Mailing Address - Fax:808-589-1576
Practice Address - Street 1:615 PIIKOI
Practice Address - Street 2:SUIT 1409
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-596-8038
Practice Address - Fax:808-589-1576
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI337103T00000X, 103TC2200X
HI41495103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent