Provider Demographics
NPI:1023352879
Name:WRIGHT, STACY M (LPC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201B W BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2536
Mailing Address - Country:US
Mailing Address - Phone:864-509-0435
Mailing Address - Fax:
Practice Address - Street 1:451 HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4304
Practice Address - Country:US
Practice Address - Phone:864-509-0435
Practice Address - Fax:864-509-0250
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-18
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5779101YP2500X, 101YS0200X, 101YM0800X
SC7316104100000X
SC7380171M00000X
SD7316171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator