MEDICARE: VICKIE ANN 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1659991834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKIE ANN WRIGHT

Provider Business Mailing Address
First Line	:	25900 GREENFIELD RD STE 411
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1287
Country	:	US
Telephone Number	:	313-790-5905
Fax Number	:

Provider Business Practice Location Address
First Line	:	25900 GREENFIELD RD STE 411
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1287
Country	:	US
Telephone Number	:	313-790-5905
Fax Number	:

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

Provider Enumeration Date	:	04/17/2020
Last Update Date	:	04/17/2020

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