Provider Demographics
NPI:1922273853
Name:WRIGHT, JACQUELINE J (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3764 HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5570
Mailing Address - Country:US
Mailing Address - Phone:678-418-5972
Mailing Address - Fax:678-418-3279
Practice Address - Street 1:4153C FLAT SHOALS PKWY
Practice Address - Street 2:SUITE 320-F
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4858
Practice Address - Country:US
Practice Address - Phone:678-418-5972
Practice Address - Fax:678-418-3279
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 003827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional