Provider Demographics
NPI:1184066250
Name:WOOD, ANGELA RENEE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENEE
Last Name:WOOD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6711
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0914
Mailing Address - Country:US
Mailing Address - Phone:304-242-6722
Mailing Address - Fax:304-242-6822
Practice Address - Street 1:99 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2421
Practice Address - Country:US
Practice Address - Phone:304-242-6722
Practice Address - Fax:304-242-6822
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-13767103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst