Provider Demographics
NPI:1699908012
Name:WOOD, PAMELA S (LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:S
Last Name:WOOD
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WOOD BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29130-9368
Mailing Address - Country:US
Mailing Address - Phone:803-635-3900
Mailing Address - Fax:
Practice Address - Street 1:3050 LEAPHART RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3000
Practice Address - Country:US
Practice Address - Phone:803-791-0495
Practice Address - Fax:803-791-1958
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC64901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical