Provider Demographics
NPI:1508579863
Name:WRIGHT, JELICIA (MS, ALC)
Entity Type:Individual
Prefix:MISS
First Name:JELICIA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9283 W US 84
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36352-8207
Mailing Address - Country:US
Mailing Address - Phone:334-692-4455
Mailing Address - Fax:334-692-4457
Practice Address - Street 1:4020 INDEPENDENCE DR NW # 704
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-3012
Practice Address - Country:US
Practice Address - Phone:872-223-2439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC4154AOtherASSOCIATE COUNSELOR LICENSE