Basic Information
| Provider Information | |||||||||
| NPI: | 1407516115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MA, LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 EAGLE SPRINGS CT | ||||||||
| Address2: | |||||||||
| City: | CLARKSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483485044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135988105 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 SOUTH BLVD W STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483075184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488242595 | ||||||||
| FaxNumber: | 2488446237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2021 | ||||||||
| LastUpdateDate: | 12/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6451020876 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.