Provider Demographics
NPI:1871773374
Name:WOOD, JOHN CARL (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CARL
Last Name:WOOD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7363 HALL RD
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:31738-2407
Mailing Address - Country:US
Mailing Address - Phone:229-228-5192
Mailing Address - Fax:229-228-5139
Practice Address - Street 1:7363 HALL RD
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:GA
Practice Address - Zip Code:31738-2407
Practice Address - Country:US
Practice Address - Phone:229-228-5192
Practice Address - Fax:229-228-5139
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0029281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical