Healthcare Provider Details

I. General information

NPI: 1780591065
Provider Name (Legal Business Name): KARLEKE OLIVER WOOD LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KARLEKE OLIVER WOOD LMSW

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8626 AIRWAYS BLVD
SOUTHAVEN MS
38671-2603
US

IV. Provider business mailing address

8626 AIRWAYS BLVD
SOUTHAVEN MS
38671-2603
US

V. Phone/Fax

Practice location:
  • Phone: 662-772-5937
  • Fax: 662-772-5940
Mailing address:
  • Phone: 662-772-5937
  • Fax: 662-772-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-12096
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: