Provider Demographics
NPI:1447476288
Name:WOOD, ALISA MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:MICHELLE
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:MICHELLE
Other - Last Name:ZIEGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:714 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-477-9800
Mailing Address - Fax:530-477-9803
Practice Address - Street 1:714 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-477-9800
Practice Address - Fax:530-477-9803
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27981104100000X
1041C0700X, 1041C0700X
CA19901104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker