Provider Demographics
NPI:1730399841
Name:WOOD, SOPHIE MARTIN (MHDL)
Entity type:Individual
Prefix:MS
First Name:SOPHIE
Middle Name:MARTIN
Last Name:WOOD
Suffix:
Gender:F
Credentials:MHDL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19031 NATALIE MICHELLE LN
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5697
Mailing Address - Country:US
Mailing Address - Phone:704-896-7284
Mailing Address - Fax:
Practice Address - Street 1:2014 PARK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2400
Practice Address - Country:US
Practice Address - Phone:704-299-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional