Provider Demographics
NPI:1225023740
Name:WOOD, MITZI ZEPHRONIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MITZI
Middle Name:ZEPHRONIA
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MITZI
Other - Middle Name:ZEPHRONIA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:712 WOODED TRL
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-2648
Mailing Address - Country:US
Mailing Address - Phone:210-560-7912
Mailing Address - Fax:
Practice Address - Street 1:1380 PANTHEON WAY STE 230
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2292
Practice Address - Country:US
Practice Address - Phone:210-560-7912
Practice Address - Fax:210-455-0500
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16911041C0700X
TX333991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical