Provider Demographics
NPI:1063648582
Name:WRIGHT, MARY ELLEN (MED,NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELLEN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MED,NCC, LPC
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:915 BINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2841
Mailing Address - Country:US
Mailing Address - Phone:910-483-8713
Mailing Address - Fax:910-483-0962
Practice Address - Street 1:915 BINGHAM DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2841
Practice Address - Country:US
Practice Address - Phone:910-483-8713
Practice Address - Fax:910-483-0962
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YS0200X
NC2311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool