1629267901 NPI number — LESLIE L WRIGHT LPC, NCC, ADC, ASDCS

NPI Number: 1629267901
Health Care Provider/Practitioner: LESLIE L WRIGHT LPC, NCC, ADC, ASDCS

NPI Number : 1629267901 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629267901",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WRIGHT",
    "FirstName": "LESLIE",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LPC, NCC, ADC, ASDCS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "607 3RD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KINGSTREE",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29556-2819",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "843-372-3365",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "204 SHORT ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KINGSTREE",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29556-3927",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-806-2501",
    "PracticeLocationAddressFaxNumber": "843-484-3641",
    "EnumerationDate": "10/23/2007",
    "LastUpdateDate": "08/10/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "18022210",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "7515",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}