MEDICARE: PATRICIA WOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	6801095863	MI
2	1041C0700X	Clinical Social Worker	1386034239	MI

General Provider Information

NPI Number	:	1386034239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA WOOD

Provider Business Mailing Address
First Line	:	527 ELIZABETH ST
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-3430
Country	:	US
Telephone Number	:	517-862-2197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 S WASHINGTON AVE
Second Line	:	SUITE 210
City	:	LANSING
State	:	MI
Zip	:	48910-0828
Country	:	US
Telephone Number	:	517-371-1111
Fax Number	:	517-371-1121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2015
Last Update Date	:	12/21/2023

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Directions to “ PATRICIA WOOD ” Practice Location

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