Provider Demographics
NPI:1760822555
Name:WOOD, KORY MARLENE (NCC)
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:MARLENE
Last Name:WOOD
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5932 W AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3787
Mailing Address - Country:US
Mailing Address - Phone:318-229-6236
Mailing Address - Fax:
Practice Address - Street 1:429 MURRAY ST
Practice Address - Street 2:4TH FL., SUITE 1
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8300
Practice Address - Country:US
Practice Address - Phone:318-229-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LA5060101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health