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General NPI Number Information
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NPI Number | 1578132049
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Entity Type | Individual
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Provider Name | NICOLE EMILY WOOD LCSWA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 3050 RIVERWOOD PKWY STE B
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City | GASTONIA
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State | NC
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Zip | 28056-6002
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Country | US
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Telephone | 704-874-9005
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Fax |
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Provider Business Mailing Address
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Address Line | 200 E 2ND AVE
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City | GASTONIA
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State | NC
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Zip | 28052-4358
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Country | US
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Telephone | 704-730-7003
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.177066
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 171M00000X
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P021733
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License Number State | NC
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