Provider Demographics
NPI:1144805193
Name:WRIGHT, GWENDOLYN DENICE (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:DENICE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W 5TH AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2907
Mailing Address - Country:US
Mailing Address - Phone:615-407-4118
Mailing Address - Fax:
Practice Address - Street 1:1350 W 5TH AVE STE 112
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2907
Practice Address - Country:US
Practice Address - Phone:615-407-4118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OHC.2103912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor