Provider Demographics
NPI:1821434606
Name:WOOD, WENDI ACKLEN (LPC)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:ACKLEN
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPC
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 2582
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-2582
Mailing Address - Country:US
Mailing Address - Phone:601-460-0191
Mailing Address - Fax:601-336-0968
Practice Address - Street 1:12337 ASHLEY DR STE C
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2753
Practice Address - Country:US
Practice Address - Phone:601-460-0191
Practice Address - Fax:601-336-0968
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional