Provider Demographics
NPI:1447729470
Name:WOOD, KASEY ALEXIS (MS, RBT, CCLS)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:ALEXIS
Last Name:WOOD
Suffix:
Gender:F
Credentials:MS, RBT, CCLS
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:ALEXIS
Other - Last Name:TRAVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1018 N BRAGG BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-3316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1018 N BRAGG BLVD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-3316
Practice Address - Country:US
Practice Address - Phone:717-512-7252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC180932128914106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician