Healthcare Provider Details

I. General information

NPI: 1417638578
Provider Name (Legal Business Name): MR. MARK EDWIN WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SPRATT ST STE B
FORT MILL SC
29715-4111
US

IV. Provider business mailing address

2714 N DAVIDSON STREET
CHARLOTTE NC
28205
US

V. Phone/Fax

Practice location:
  • Phone: 214-966-2579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8727
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: