Provider Demographics
NPI:1407516115
Name:WOOD, MARISSA LEE (LPC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LEE
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24055 JEFFERSON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1513
Mailing Address - Country:US
Mailing Address - Phone:586-445-2210
Mailing Address - Fax:586-445-0070
Practice Address - Street 1:1460 WALTON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1779
Practice Address - Country:US
Practice Address - Phone:248-844-6234
Practice Address - Fax:248-844-6237
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6451020876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional