Provider Demographics
NPI:1881348365
Name:WOOD, COURTNEY WILSON (LICSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:WILSON
Last Name:WOOD
Suffix:
Gender:M
Credentials:LICSW
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 130358
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-0358
Mailing Address - Country:US
Mailing Address - Phone:205-541-8434
Mailing Address - Fax:
Practice Address - Street 1:529 BEACON PKWY W STE 105
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3126
Practice Address - Country:US
Practice Address - Phone:205-541-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4905C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical