Healthcare Provider Details

I. General information

NPI: 1053551176
Provider Name (Legal Business Name): FAITH JOY WRIGHT, PSYCHOTHERAPIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 ROCKBRIDGE RD ST. E
STONE MOUNTAIN GA
30087-3163
US

IV. Provider business mailing address

PO BOX 870393
STONE MOUNTAIN GA
30087-0010
US

V. Phone/Fax

Practice location:
  • Phone: 770-381-2230
  • Fax: 770-381-2223
Mailing address:
  • Phone: 770-381-2230
  • Fax: 770-381-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW001828
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAITH JOY WRIGHT
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: PH.D., LCSW
Phone: 770-381-2230