Provider Demographics
NPI:1245649581
Name:WRIGHT, MIA Y (MBA, LCSW)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:Y
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MBA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7794 FLYAWAY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3511
Mailing Address - Country:US
Mailing Address - Phone:770-875-5504
Mailing Address - Fax:866-260-5504
Practice Address - Street 1:2011 COMMERCE DR N
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3538
Practice Address - Country:US
Practice Address - Phone:470-483-6929
Practice Address - Fax:866-260-5504
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 251S00000X
GACSW0063851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174H00000XOther Service ProvidersHealth Educator
No251S00000XAgenciesCommunity/Behavioral Health