Provider Demographics
NPI:1467444836
Name:WRIGHT, MARTHA ANN (PHD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:WRIGHT
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6224 FAYETTEVILLE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6288
Mailing Address - Country:US
Mailing Address - Phone:919-439-6120
Mailing Address - Fax:919-246-4420
Practice Address - Street 1:6224 FAYETTEVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6288
Practice Address - Country:US
Practice Address - Phone:919-439-6120
Practice Address - Fax:919-246-4420
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2833103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00036711OtherRR MEDICARE
NC6000598Medicaid
61-00244OtherEVERCARE
NC045XUOtherBCBSNC
NC6000598Medicaid