MEDICARE: MRS. REKETTA CHARMETT WRIGHT

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	7646	NC

General Provider Information

NPI Number	:	1427195098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REKETTA CHARMETT WRIGHT

Provider Business Mailing Address
First Line	:	2311 W CONE BLVD STE 223
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-4067
Country	:	US
Telephone Number	:	336-542-2884
Fax Number	:	336-542-2885

Provider Business Practice Location Address
First Line	:	204 MUIRS CHAPEL RD
Second Line	:	STE 305
City	:	GREENSBORO
State	:	NC
Zip	:	27410-6173
Country	:	US
Telephone Number	:	336-816-2389
Fax Number	:	336-542-2885

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	09/28/2023

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