Provider Demographics
NPI:1790471118
Name:WRIGHT, LEVON III
Entity Type:Individual
Prefix:
First Name:LEVON
Middle Name:
Last Name:WRIGHT
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 GRELOT RD STE G1016
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3602
Mailing Address - Country:US
Mailing Address - Phone:850-529-1877
Mailing Address - Fax:
Practice Address - Street 1:6300 GRELOT RD STE G1016
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3602
Practice Address - Country:US
Practice Address - Phone:850-529-1877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL171W00000X
ALLXW-0109-8730101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171W00000XOther Service ProvidersContractor