Provider Demographics
NPI:1033083563
Name:WISE-WRIGHT, ABIGAIL GRACE I
Entity type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:GRACE
Last Name:WISE-WRIGHT
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 BAY ST APT 328
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4243
Mailing Address - Country:US
Mailing Address - Phone:949-287-5784
Mailing Address - Fax:
Practice Address - Street 1:4227 BAY ST APT 328
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4243
Practice Address - Country:US
Practice Address - Phone:949-287-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty