Provider Demographics
NPI:1184788192
Name:WRIGHT, JOHN DANIEL (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DANIEL
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 WHEELER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6550
Mailing Address - Country:US
Mailing Address - Phone:706-364-0252
Mailing Address - Fax:706-364-0269
Practice Address - Street 1:3633 WHEELER RD STE 100
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909
Practice Address - Country:US
Practice Address - Phone:706-364-0252
Practice Address - Fax:706-364-0269
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0008751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical