Healthcare Provider Details

I. General information

NPI: 1720982093
Provider Name (Legal Business Name): JAEL AAYANNA WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7147 MOUNT ZION CIR APT 8105
MORROW GA
30260-3349
US

IV. Provider business mailing address

7147 MOUNT ZION CIR APT 8105
MORROW GA
30260-3349
US

V. Phone/Fax

Practice location:
  • Phone: 803-942-6381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC17086
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: