Healthcare Provider Details

I. General information

NPI: 1326854167
Provider Name (Legal Business Name): MARLENE WRIGHT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 PROFESSIONAL RD STE E
NORTH CHESTERFIELD VA
23235-3267
US

IV. Provider business mailing address

2520 PROFESSIONAL RD STE E
NORTH CHESTERFIELD VA
23235-3267
US

V. Phone/Fax

Practice location:
  • Phone: 804-220-0071
  • Fax:
Mailing address:
  • Phone: 804-220-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARLENE WRIGHT
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 804-220-0071