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General NPI Number Information
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NPI Number | 1376206102
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Entity Type | Individual
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Provider Name | JAZMINE CAMILLE WOOD
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Gender | Female
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 408 S SYCAMORE ST STE 4
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City | PETERSBURG
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State | VA
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Zip | 23803-5043
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Country | US
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Telephone | 804-668-7217
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 613
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-0613
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704012204
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License Number State | VA
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