Provider Demographics
NPI:1790738201
Name:DUCIAUME-WRIGHT, COLETTE LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:LYNN
Last Name:DUCIAUME-WRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 E BITTERS RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4448
Mailing Address - Country:US
Mailing Address - Phone:210-822-6083
Mailing Address - Fax:210-637-6315
Practice Address - Street 1:2546 E BITTERS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4448
Practice Address - Country:US
Practice Address - Phone:210-822-6083
Practice Address - Fax:210-637-6315
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142309OtherVALUE OPTIONS - SOCIAL WO
TX00665EOtherBCBS - SOCIAL WORKER
TX0639056-01Medicaid
TX0639056-01Medicaid