Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701002721 | VA |
NPI | 1003872524 |
---|---|
Provider Name | Jason Wright |
First Address | Lynchburg, VA 24503-3321 |
Second Address | Lynchburg, VA 24503-3321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 30/07/2015 |