Healthcare Provider Details

I. General information

NPI: 1679646285
Provider Name (Legal Business Name): CAROL JOAN WOOD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PIIKOI SUIT 1409
HONOLULU HI
96814
US

IV. Provider business mailing address

615 PIIKOI SUIT 1409
HONOLULU HI
96814
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-8038
  • Fax: 808-589-1576
Mailing address:
  • Phone: 808-596-8038
  • Fax: 808-589-1576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number337
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number41495
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number337
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: