Provider Demographics
NPI:1285019166
Name:WRIGHT, VERNICE L (EDD,LCPC, CADC, CODP)
Entity Type:Individual
Prefix:DR
First Name:VERNICE
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:EDD,LCPC, CADC, CODP
Other - Prefix:DR
Other - First Name:VERNICE
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, NCC, LCPC, CADC
Mailing Address - Street 1:2504 WASHINGTON ST # 300BC
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4983
Mailing Address - Country:US
Mailing Address - Phone:224-489-7773
Mailing Address - Fax:
Practice Address - Street 1:2504 WASHINGTON ST
Practice Address - Street 2:SUITE # 300 B/C
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4983
Practice Address - Country:US
Practice Address - Phone:224-489-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILMISA 21481101Y00000X
ILCADC 21481101YA0400X
IL178.010358101YP2500X
IL180.009793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional