Provider Demographics
NPI:1184717431
Name:WRIGHT, CHARLES DARRELL II (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DARRELL
Last Name:WRIGHT
Suffix:II
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8504 HOBHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-8111
Mailing Address - Country:US
Mailing Address - Phone:919-327-3681
Mailing Address - Fax:
Practice Address - Street 1:5003 SOUTHPARK DR STE 120
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9414
Practice Address - Country:US
Practice Address - Phone:919-753-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102919Medicaid