Provider Demographics
NPI:1386826360
Name:WRIGHT, CANDACE GARDNER (MED)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:GARDNER
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2343
Mailing Address - Country:US
Mailing Address - Phone:304-926-1688
Mailing Address - Fax:304-925-1524
Practice Address - Street 1:5600 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2343
Practice Address - Country:US
Practice Address - Phone:304-926-1688
Practice Address - Fax:304-925-1524
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV364103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist