Provider Demographics
NPI:1770652612
Name:WRIGHT, PATRICIA EVANS (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EVANS
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:COHUTTA
Mailing Address - State:GA
Mailing Address - Zip Code:30710-9323
Mailing Address - Country:US
Mailing Address - Phone:706-694-2226
Mailing Address - Fax:706-602-9359
Practice Address - Street 1:654 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1963
Practice Address - Country:US
Practice Address - Phone:706-602-0339
Practice Address - Fax:706-602-9359
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002287103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000824106DMedicaid