Provider Demographics
NPI:1720533102
Name:WRIGHT, WILLIS JAMES II (LCSWA)
Entity Type:Individual
Prefix:
First Name:WILLIS
Middle Name:JAMES
Last Name:WRIGHT
Suffix:II
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 HABERSHAM DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6325
Mailing Address - Country:US
Mailing Address - Phone:336-749-9454
Mailing Address - Fax:410-778-7988
Practice Address - Street 1:3 CENTERVIEW DR
Practice Address - Street 2:THE HICKORY BLDG STE 150
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3725
Practice Address - Country:US
Practice Address - Phone:336-834-9664
Practice Address - Fax:410-778-7988
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP010877104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker