Provider Demographics
NPI:1871660415
Name:WRIGHT, J. GRETCHEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:J.
Middle Name:GRETCHEN
Last Name: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 1:905 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5352
Mailing Address - Country:US
Mailing Address - Phone:423-989-7755
Mailing Address - Fax:423-989-7657
Practice Address - Street 1:1104 VOLUNTEER PKWY STE 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4666
Practice Address - Country:US
Practice Address - Phone:423-989-7755
Practice Address - Fax:423-989-7657
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34881041C0700X
VA09040039991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3699358Medicaid
VA3699359Medicaid
VAC08199Medicare ID - Type UnspecifiedRHR GROUP #
TN3699359Medicare ID - Type UnspecifiedKINGSPORT
TN3923893Medicare ID - Type UnspecifiedBRISTOL GROUP ID
VA3699359Medicaid
TN3699358Medicare ID - Type UnspecifiedBRISTOL
TN3923892Medicare ID - Type UnspecifiedKINGSPORT GROUP NUMBER
TN3920130Medicare PIN