Provider Demographics
NPI:1588488993
Name:WRIGHT-JACK, CORINA (LPC)
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:WRIGHT-JACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 N 106TH DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4465
Mailing Address - Country:US
Mailing Address - Phone:480-450-2362
Mailing Address - Fax:480-999-3324
Practice Address - Street 1:2066 W APACHE TRL STE 101
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3733
Practice Address - Country:US
Practice Address - Phone:480-999-3323
Practice Address - Fax:480-999-3324
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23335101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health