Provider Demographics
NPI:1104614791
Name:WRIGHT, CORNETT ARDIANNA (ADMISTRATIVE MANGER)
Entity type:Individual
Prefix:
First Name:CORNETT
Middle Name:ARDIANNA
Last Name:WRIGHT
Suffix:
Gender:
Credentials:ADMISTRATIVE MANGER
Other - Prefix:MRS
Other - First Name:CORNETT
Other - Middle Name:ADRIANNA
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16600 SHERMAN WAY STE 178
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3875
Mailing Address - Country:US
Mailing Address - Phone:818-235-1414
Mailing Address - Fax:818-235-1418
Practice Address - Street 1:16600 SHERMAN WAY STE 178
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3875
Practice Address - Country:US
Practice Address - Phone:818-235-1414
Practice Address - Fax:818-235-1418
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCABA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician