Provider Demographics
NPI:1720278021
Name:WOOD, JAMES C (LMSW, LMFT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:WOOD
Suffix:
Gender:M
Credentials:LMSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 CLAYSTONE ST SE
Mailing Address - Street 2:STE 212
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5781
Mailing Address - Country:US
Mailing Address - Phone:616-954-1991
Mailing Address - Fax:616-954-1998
Practice Address - Street 1:3351 CLAYSTONE ST SE
Practice Address - Street 2:STE 212
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5781
Practice Address - Country:US
Practice Address - Phone:616-954-1991
Practice Address - Fax:616-954-1998
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801014952104100000X
MI4101005363106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker