Provider Demographics
NPI:1932278470
Name:WOOD, GARY D (MSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:D
Last Name:WOOD
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5253 LIPPINCOTT
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519
Mailing Address - Country:US
Mailing Address - Phone:819-743-6189
Mailing Address - Fax:810-733-0911
Practice Address - Street 1:4511 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1107
Practice Address - Country:US
Practice Address - Phone:810-733-0911
Practice Address - Fax:810-733-0911
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010123641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM56020Medicare ID - Type UnspecifiedLCSW