Healthcare Provider Details

I. General information

NPI: 1285108357
Provider Name (Legal Business Name): ERIC WOOD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 MAUREY RD
JACKSON MS
39211
US

IV. Provider business mailing address

1220 E NORTHSIDE DRIVE SUITE 170 #188
JACKSON MS
39211
US

V. Phone/Fax

Practice location:
  • Phone: 601-613-0328
  • Fax:
Mailing address:
  • Phone: 601-613-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1603
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1603
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: