Basic Information
| Provider Information | |||||||||
| NPI: | 1720533102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | WILLIS | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | LCSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6210 HABERSHAM DR | ||||||||
| Address2: | |||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272846325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367499454 | ||||||||
| FaxNumber: | 4107787988 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 CENTERVIEW DR | ||||||||
| Address2: | THE HICKORY BLDG STE 150 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274073725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368349664 | ||||||||
| FaxNumber: | 4107787988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2016 | ||||||||
| LastUpdateDate: | 08/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | P010877 | NC | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.