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General NPI Number Information
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NPI Number | 1407516115
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Entity Type | Individual
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Provider Name | MARISSA LEE WOOD LPC
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Gender | Female
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 1460 WALTON BLVD STE 120
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-1779
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Country | US
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Telephone | 248-844-6234
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Fax | 248-844-6237
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Provider Business Mailing Address
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Address Line | 24055 JEFFERSON AVE STE 103
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1513
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Country | US
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Telephone | 586-445-2210
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Fax | 586-445-0070
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451020876
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License Number State | MI
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