Healthcare Provider Details

I. General information

NPI: 1407516115
Provider Name (Legal Business Name): MARISSA LEE WOOD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD STE 120
ROCHESTER HILLS MI
48309-1779
US

IV. Provider business mailing address

24055 JEFFERSON AVE STE 103
SAINT CLAIR SHORES MI
48080-1513
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-6234
  • Fax: 248-844-6237
Mailing address:
  • Phone: 586-445-2210
  • Fax: 586-445-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451020876
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: