Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 5580 | SC |
N | 101YP2500X | Professional Counselor | 5779 | SC |
N | 101YS0200X | School Counselor | 5779 | SC |
N | 104100000X | Social Worker | 7316 | SC |
NPI | 1023352879 |
---|---|
Provider Name | Mrs. Stacy Yvonne Wright |
First Address | Mauldin, SC 29662-2536 |
Second Address | Simpsonville, SC 29681-6128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2012 |
Last Update Date | 09/01/2016 |