Healthcare Provider Details

I. General information

NPI: 1285019166
Provider Name (Legal Business Name): VERNICE L WRIGHT EDD,LCPC, CADC, CODP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VERNICE WRIGHT EDD, NCC, LCPC, CADC

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 05/09/2020
Certification Date: 05/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 WASHINGTON ST SUITE # 300 B/C
WAUKEGAN IL
60085-4983
US

IV. Provider business mailing address

2504 WASHINGTON ST # 300BC
WAUKEGAN IL
60085-4983
US

V. Phone/Fax

Practice location:
  • Phone: 224-489-7773
  • Fax:
Mailing address:
  • Phone: 224-489-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMISA 21481
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC 21481
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.010358
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.009793
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: