MEDICARE: EBONY TIARA WRIGHT MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C012383	NC
2	1041C0700X	Clinical Social Worker	13371	SC

General Provider Information

NPI Number	:	1346771318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY TIARA WRIGHT MSW, LCSW

Provider Business Mailing Address
First Line	:	1985 RIVIERA DR STE 103
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-7582
Country	:	US
Telephone Number	:	843-781-1449
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 FABER PLACE DR STE 300
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8587
Country	:	US
Telephone Number	:	843-781-1449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	08/04/2025

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