Provider Demographics
NPI:1720606387
Name:WOOD, AUTUMN MARIE (BA, CADC)
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:MARIE
Last Name:WOOD
Suffix:
Gender:F
Credentials:BA, CADC
Other - Prefix:MS
Other - First Name:AUTUMN
Other - Middle Name:MARIE
Other - Last Name:WOODHOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, CADC
Mailing Address - Street 1:777 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4147
Mailing Address - Country:US
Mailing Address - Phone:413-418-5573
Mailing Address - Fax:
Practice Address - Street 1:777 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4147
Practice Address - Country:US
Practice Address - Phone:413-418-5573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1885AD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty