Provider Demographics
NPI:1720519994
Name:WOOD, JESSICA (LCPC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14901 BROSCHART RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3318
Mailing Address - Country:US
Mailing Address - Phone:301-251-4500
Mailing Address - Fax:301-251-4505
Practice Address - Street 1:14901 BROSCHART RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3318
Practice Address - Country:US
Practice Address - Phone:301-251-4500
Practice Address - Fax:301-251-4505
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional