Provider Demographics
NPI:1790540847
Name:WRIGHTSON, NISSA C
Entity Type:Individual
Prefix:
First Name:NISSA
Middle Name:C
Last Name:WRIGHTSON
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 1:41 ROCKY POND RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MA
Mailing Address - Zip Code:01541-1014
Mailing Address - Country:US
Mailing Address - Phone:978-478-8936
Mailing Address - Fax:
Practice Address - Street 1:41 ROCKY POND RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MA
Practice Address - Zip Code:01541-1014
Practice Address - Country:US
Practice Address - Phone:978-478-8936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23104101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)