Provider Demographics
NPI:1346771318
Name:WRIGHT, EBONY TIARA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:TIARA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 RIVIERA DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7582
Mailing Address - Country:US
Mailing Address - Phone:843-781-1449
Mailing Address - Fax:
Practice Address - Street 1:1985 RIVIERA DR STE 103
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7582
Practice Address - Country:US
Practice Address - Phone:843-781-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0123831041C0700X
SC133711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical