Basic Information
| Provider Information | |||||||||
| NPI: | 1386041200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LMHC, LCDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 JEAN DR | ||||||||
| Address2: | |||||||||
| City: | SEEKONK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027713223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012792167 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 HOPE ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029062001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013311350 | ||||||||
| FaxNumber: | 4012773385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2014 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CDP00577 | RI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | MHC00930 | RI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.