Provider Demographics
NPI:1164593828
Name:WRIGHT, FAITH JOY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:FAITH
Middle Name:JOY
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870393
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-0010
Mailing Address - Country:US
Mailing Address - Phone:404-299-0490
Mailing Address - Fax:404-299-0492
Practice Address - Street 1:5300 MEMORIAL DR
Practice Address - Street 2:212
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3148
Practice Address - Country:US
Practice Address - Phone:404-299-0490
Practice Address - Fax:404-299-0492
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBGBTMedicare ID - Type Unspecified
GAQ29226Medicare UPIN