Provider Demographics
NPI:1497588594
Name:WOOD, ALVIN THOMAS (LPC)
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:THOMAS
Last Name:WOOD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N BRIDGE ST APT A
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1547
Mailing Address - Country:US
Mailing Address - Phone:757-561-7108
Mailing Address - Fax:
Practice Address - Street 1:60 BUSH RIVER DR
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-3178
Practice Address - Country:US
Practice Address - Phone:434-392-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013837101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional