Individual
STACEY WRIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2370 MAIN ST, TUCKER, GA 30084-4456
(678) 253-2292
Mailing address
2789 WILSON GLN, DECATUR, GA 30033-1457
(404) 227-0055
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
APC007921
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APC007921
GEORGIA SECRETARY OF STATE
GA
Enumeration date
06/01/2021
Last updated
06/01/2021
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