Provider Demographics
NPI:1649690983
Name:WRIGHT, SERINA DAWN MYLES (MA, EDS, NCSP)
Entity type:Individual
Prefix:MS
First Name:SERINA
Middle Name:DAWN MYLES
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MA, EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MCKINLEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1717
Mailing Address - Country:US
Mailing Address - Phone:330-452-1672
Mailing Address - Fax:
Practice Address - Street 1:305 MCKINLEY AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1717
Practice Address - Country:US
Practice Address - Phone:330-452-1672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3107963103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool