Provider Demographics
NPI:1023258985
Name:WRIGHT, KEITH C SR (ICADC, CSAC, ADC-II)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:C
Last Name:WRIGHT
Suffix:SR
Gender:M
Credentials:ICADC, CSAC, ADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NEW BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4708
Mailing Address - Country:US
Mailing Address - Phone:910-389-6714
Mailing Address - Fax:910-347-4037
Practice Address - Street 1:230 NEW BRIDGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4708
Practice Address - Country:US
Practice Address - Phone:910-389-6714
Practice Address - Fax:910-347-4037
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2058101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)