Healthcare Provider Details

I. General information

NPI: 1609349190
Provider Name (Legal Business Name): ASHLEY WOOD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 MENDOCINO AVE
SANTA ROSA CA
95401-4312
US

IV. Provider business mailing address

110 STONY POINT RD STE 210
SANTA ROSA CA
95401-4118
US

V. Phone/Fax

Practice location:
  • Phone: 707-890-3850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: