Provider Demographics
NPI:1053162214
Name:WRIGHT, DAMONIQUE MIRACLE
Entity type:Individual
Prefix:
First Name:DAMONIQUE
Middle Name:MIRACLE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 BROAD MEADOWS BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1057
Mailing Address - Country:US
Mailing Address - Phone:380-710-1493
Mailing Address - Fax:
Practice Address - Street 1:4664 LARWELL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3621
Practice Address - Country:US
Practice Address - Phone:614-487-7805
Practice Address - Fax:614-487-7809
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician