Provider Demographics
NPI:1902660954
Name:WRIGHT, DARRELL T (CPSS)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:T
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 T ST NE APT 254
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5128
Mailing Address - Country:US
Mailing Address - Phone:202-910-3902
Mailing Address - Fax:202-610-3095
Practice Address - Street 1:116 T ST NE APT 254
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5128
Practice Address - Country:US
Practice Address - Phone:202-910-3902
Practice Address - Fax:202-601-3095
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No171M00000XOther Service ProvidersCase Manager/Care Coordinator