Basic Information
| Provider Information | |||||||||
| NPI: | 1346771318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | EBONY | ||||||||
| MiddleName: | TIARA | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2511 OLD CORNWALLIS RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277131869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199325700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2511 OLD CORNWALLIS RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277131869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199325700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 11/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P011098 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C012383 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.