Provider Demographics
NPI:1326810185
Name:WRIGHT, KEONA SHANTEA (BT)
Entity Type:Individual
Prefix:
First Name:KEONA
Middle Name:SHANTEA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 TERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4548
Mailing Address - Country:US
Mailing Address - Phone:757-266-9088
Mailing Address - Fax:
Practice Address - Street 1:4310 TERRY DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-4548
Practice Address - Country:US
Practice Address - Phone:757-266-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician