Provider Demographics
NPI:1154452266
Name:WRIGHT, ALFREDA
Entity Type:Individual
Prefix:
First Name:ALFREDA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58923 BUSINESS CENTER DR STE E
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-7311
Mailing Address - Country:US
Mailing Address - Phone:760-365-7209
Mailing Address - Fax:760-365-7946
Practice Address - Street 1:58923 BUSINESS CENTER DR STE E
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7311
Practice Address - Country:US
Practice Address - Phone:760-365-7209
Practice Address - Fax:760-365-7946
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator