Healthcare Provider Details

I. General information

NPI: 1851500193
Provider Name (Legal Business Name): JAMES M WRIGHT LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 ALFRED ST PARK 111
BIDDEFORD ME
04005-3741
US

IV. Provider business mailing address

PO BOX 787
ELLSWORTH ME
04605-0787
US

V. Phone/Fax

Practice location:
  • Phone: 207-284-4629
  • Fax:
Mailing address:
  • Phone: 207-667-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCC891
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: