MEDICARE: SHANA WRIGHT WOOD LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC011719	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC011719	OTHER	GA	GA BOARD OF PROFESSIONAL COUNSELORS, SOCIAL WORKERS, AND AND MFT'S

General Provider Information

NPI Number	:	1043824097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA WRIGHT WOOD LPC

Provider Business Mailing Address
First Line	:	741 PIEDMONT AVE NE STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-1420
Country	:	US
Telephone Number	:	404-232-5775
Fax Number	:

Provider Business Practice Location Address
First Line	:	741 PIEDMONT AVE NE STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-1420
Country	:	US
Telephone Number	:	404-232-5775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2020
Last Update Date	:	09/06/2020

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Directions to “ SHANA WRIGHT WOOD LPC” Practice Location

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