Provider Demographics
NPI:1265218861
Name:WRIGHT, MAE SLAY
Entity type:Individual
Prefix:
First Name:MAE
Middle Name:SLAY
Last Name:WRIGHT
Suffix:
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 1:131 GLENWOOD BND
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6571
Mailing Address - Country:US
Mailing Address - Phone:662-386-0840
Mailing Address - Fax:
Practice Address - Street 1:1437 OLD SQUARE RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5533
Practice Address - Country:US
Practice Address - Phone:601-977-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker