Provider Demographics
NPI:1336780469
Name:WRIGHT, TRACY HAM
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:HAM
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 1:1365 ASHLEY RIVER RD STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5379
Mailing Address - Country:US
Mailing Address - Phone:843-284-9636
Mailing Address - Fax:
Practice Address - Street 1:1365 ASHLEY RIVER RD STE D
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5379
Practice Address - Country:US
Practice Address - Phone:843-284-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health