Provider Demographics
NPI:1942298864
Name:WRIGHT, SUSAN C (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
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 1:124 NORTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHERRYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28021-8314
Mailing Address - Country:US
Mailing Address - Phone:704-476-8078
Mailing Address - Fax:704-476-8303
Practice Address - Street 1:315 PATTON DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5429
Practice Address - Country:US
Practice Address - Phone:704-476-8078
Practice Address - Fax:704-476-8303
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003959A1041C0700X
NCC0067601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007669Medicaid
IN100073590Medicaid