Provider Demographics
NPI:1689034076
Name:WRIGHT, HEATHER JADE (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JADE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:JADE
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:979 E 3RD ST STE B1010
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-778-2965
Mailing Address - Fax:423-778-2966
Practice Address - Street 1:979 E 3RD ST STE B1010
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-2965
Practice Address - Fax:423-778-2966
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN68391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP620330875530OtherDRIVER'S LICENSE