Provider Demographics
NPI:1265584759
Name:WAINWRIGHT, MISTY M (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:M
Last Name:WAINWRIGHT
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1213
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-1213
Mailing Address - Country:US
Mailing Address - Phone:985-898-1940
Mailing Address - Fax:985-893-3427
Practice Address - Street 1:110 LAKEVIEW DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7511
Practice Address - Country:US
Practice Address - Phone:985-898-1940
Practice Address - Fax:985-893-3427
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health