Provider Demographics
NPI:1619019270
Name:WRIGHT, LISA ANN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1235 CHATWELL DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2710
Mailing Address - Country:US
Mailing Address - Phone:810-614-4973
Mailing Address - Fax:
Practice Address - Street 1:1134 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3042
Practice Address - Country:US
Practice Address - Phone:810-667-4111
Practice Address - Fax:810-667-4111
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010860541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical