Healthcare Provider Details

I. General information

NPI: 1811459860
Provider Name (Legal Business Name): LISA DIANE WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 MILLER CREEK LN
NEWPORT NEWS VA
23602-9460
US

IV. Provider business mailing address

867 MILLER CREEK LN
NEWPORT NEWS VA
23602-9460
US

V. Phone/Fax

Practice location:
  • Phone: 757-401-0930
  • Fax:
Mailing address:
  • Phone: 757-676-2430
  • Fax: 855-375-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: