Provider Demographics
NPI:1366051088
Name:CWRIGHT, KATREASA L (LADAC)
Entity type:Individual
Prefix:
First Name:KATREASA
Middle Name:L
Last Name:CWRIGHT
Suffix:
Gender:F
Credentials:LADAC
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 292
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AR
Mailing Address - Zip Code:72359-0292
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:224 SOUTH 5TH ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AR
Practice Address - Zip Code:72359
Practice Address - Country:US
Practice Address - Phone:501-510-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR420L101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)