Healthcare Provider Details

I. General information

NPI: 1235739251
Provider Name (Legal Business Name): MICHAEL PATRICK WOOD LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5733 ALLENDER RD
WHITE MARSH MD
21162-1306
US

IV. Provider business mailing address

5733 ALLENDER RD
WHITE MARSH MD
21162-1306
US

V. Phone/Fax

Practice location:
  • Phone: 443-504-8404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC9620
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: