Provider Demographics
NPI:1871854992
Name:WOOD, ERIC (MA, LCAC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:MA, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 BROAD RIPPLE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2339
Mailing Address - Country:US
Mailing Address - Phone:317-726-0777
Mailing Address - Fax:317-726-0779
Practice Address - Street 1:1803 BROAD RIPPLE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2339
Practice Address - Country:US
Practice Address - Phone:317-726-0777
Practice Address - Fax:317-726-0779
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000353A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)