Provider Demographics
NPI:1275788101
Name:WRIGHT, LANCE W
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:W
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 EXECUTIVE DR
Mailing Address - Street 2:SUITE 3-F, BOX 32
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2404
Mailing Address - Country:US
Mailing Address - Phone:757-490-6960
Mailing Address - Fax:
Practice Address - Street 1:2101 EXECUTIVE DR
Practice Address - Street 2:SUITE 3-F, BOX 32
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2404
Practice Address - Country:US
Practice Address - Phone:757-490-6960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040048921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical