Provider Demographics
NPI:1124167952
Name:VANCE T. WOOD, PSYD, PC
Entity type:Organization
Organization Name:VANCE T. WOOD, PSYD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:706-265-1357
Mailing Address - Street 1:462 MEMORY LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-4314
Mailing Address - Country:US
Mailing Address - Phone:706-265-1357
Mailing Address - Fax:706-265-1406
Practice Address - Street 1:462 MEMORY LN
Practice Address - Street 2:SUITE 110
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-4314
Practice Address - Country:US
Practice Address - Phone:706-265-1357
Practice Address - Fax:706-265-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty