Provider Demographics
NPI:1427322031
Name:WOOD, CAROLINE M (LCAS-A)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:M
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 ATLANTIC AVE STE 209A
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1549
Mailing Address - Country:US
Mailing Address - Phone:919-457-0443
Mailing Address - Fax:919-457-0443
Practice Address - Street 1:3108 OLDE BIRCH DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-5877
Practice Address - Country:US
Practice Address - Phone:919-757-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2601101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)