Provider Demographics
NPI:1639841901
Name:WRIGHT, MICAH (ALC, NCC)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 GORDONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2903
Mailing Address - Country:US
Mailing Address - Phone:256-698-0992
Mailing Address - Fax:
Practice Address - Street 1:269 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4433
Practice Address - Country:US
Practice Address - Phone:251-244-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3918A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor