Provider Demographics
NPI:1023668621
Name:WRIGHT, STEPHEN SHAWN (CADC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:SHAWN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10057 ELKHORN CRK
Mailing Address - Street 2:
Mailing Address - City:ASHCAMP
Mailing Address - State:KY
Mailing Address - Zip Code:41512-8702
Mailing Address - Country:US
Mailing Address - Phone:606-754-7077
Mailing Address - Fax:606-754-7079
Practice Address - Street 1:10057 ELKHORN CRK
Practice Address - Street 2:
Practice Address - City:ASHCAMP
Practice Address - State:KY
Practice Address - Zip Code:41512-8702
Practice Address - Country:US
Practice Address - Phone:606-757-7077
Practice Address - Fax:606-754-7079
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165972101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)