Healthcare Provider Details

I. General information

NPI: 1346876240
Provider Name (Legal Business Name): CATHERINE MEWBORN WOOD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE MATTOCKS MEWBORN PH.D.

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 LEINBACH DR STE D4
CHARLESTON SC
29407-7086
US

IV. Provider business mailing address

6650 RIVERS AVE STE 100
NORTH CHARLESTON SC
29406-4809
US

V. Phone/Fax

Practice location:
  • Phone: 843-212-6801
  • Fax: 877-860-2868
Mailing address:
  • Phone: 843-212-6801
  • Fax: 877-860-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1929
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3712
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1929
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3712
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: