Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 3240 | CO |
NPI | 1003048919 |
---|---|
Provider Name | Andrea Wood |
First Address | Colorado Springs, CO 80906-3882 |
Second Address | Colorado Springs, CO 80906-3882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2009 |
Last Update Date | 12/08/2009 |