Provider Demographics
NPI:1790305118
Name:WRIGHT, ALEXIS (AMFT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3789 HOWARD DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6434
Mailing Address - Country:US
Mailing Address - Phone:404-514-0319
Mailing Address - Fax:
Practice Address - Street 1:2255 CUMBERLAND PKWY SE BLDG 500-140
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4524
Practice Address - Country:US
Practice Address - Phone:855-878-5325
Practice Address - Fax:404-478-8413
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health