Provider Demographics
NPI:1407153406
Name:WRIGHT, DIANE H (LMSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:H
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S SHANNON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-6830
Mailing Address - Country:US
Mailing Address - Phone:731-499-2508
Mailing Address - Fax:731-423-6125
Practice Address - Street 1:314 S SHANNON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-6830
Practice Address - Country:US
Practice Address - Phone:731-499-2508
Practice Address - Fax:731-423-6125
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000078551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical