Healthcare Provider Details

I. General information

NPI: 1962838896
Provider Name (Legal Business Name): DAVID ANDREW WOOD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 DUNDEE RD
NORTHBROOK IL
60062-2201
US

IV. Provider business mailing address

3444 DUNDEE RD
NORTHBROOK IL
60062-2201
US

V. Phone/Fax

Practice location:
  • Phone: 847-559-0110
  • Fax: 847-559-8199
Mailing address:
  • Phone: 847-559-0110
  • Fax: 847-559-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178006745
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: