Provider Demographics
NPI:1962091553
Name:WRIGHT, GREGORY T JR (LGPC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:T
Last Name:WRIGHT
Suffix:JR
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 FORTUNE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6520
Mailing Address - Country:US
Mailing Address - Phone:240-432-0027
Mailing Address - Fax:
Practice Address - Street 1:11821 PARKLAWN DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2539
Practice Address - Country:US
Practice Address - Phone:301-650-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10980101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health