Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 4159 | TN |
NPI | 1003087834 |
---|---|
Provider Name | Tara L Wood |
First Address | Chattanooga, TN 37401-2085 |
Second Address | Chattanooga, TN 37415-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2008 |
Last Update Date | 19/03/2008 |