Healthcare Provider Details

I. General information

NPI: 1720284912
Provider Name (Legal Business Name): MS. VIVIAN LYNNE WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12370 CLAY STATION RD
HERALD CA
95638-9757
US

IV. Provider business mailing address

768 GRIFFEY WAY
GALT CA
95632-3065
US

V. Phone/Fax

Practice location:
  • Phone: 209-744-9909
  • Fax:
Mailing address:
  • Phone: 209-744-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: