Provider Demographics
NPI:1689097750
Name:WRIGHT-WHITE, LYNCIA
Entity Type:Individual
Prefix:
First Name:LYNCIA
Middle Name:
Last Name:WRIGHT-WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 RASPBERRY CT SE APT M
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5973
Mailing Address - Country:US
Mailing Address - Phone:616-325-5906
Mailing Address - Fax:
Practice Address - Street 1:2148 RASPBERRY CT SE APT M
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5973
Practice Address - Country:US
Practice Address - Phone:616-325-5906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIW623564676726103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst