Provider Demographics
NPI:1982173159
Name:WRIGHT, CHRISTINE (LLMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2102
Mailing Address - Country:US
Mailing Address - Phone:517-998-4673
Mailing Address - Fax:517-998-0005
Practice Address - Street 1:207 FIRST STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2102
Practice Address - Country:US
Practice Address - Phone:517-998-4673
Practice Address - Fax:517-998-4673
Is Sole Proprietor?:No
Enumeration Date:2018-11-17
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011055191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801105519OtherLLMSW LICENSE