Provider Demographics
NPI:1710877121
Name:WOOD, MELINDA G
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:G
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 ASH ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93437-1357
Mailing Address - Country:US
Mailing Address - Phone:407-280-1771
Mailing Address - Fax:
Practice Address - Street 1:703 ASH ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93437-1357
Practice Address - Country:US
Practice Address - Phone:407-280-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CABD9259BDF8171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No104100000XBehavioral Health & Social Service ProvidersSocial Worker