Provider Demographics
NPI:1053405613
Name:WRIGHT, ELEANOR ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:ELIZABETH
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:E. ELIZABETH
Other - Middle Name:HOLT
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1970 ROANOKE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:
Practice Address - Street 1:1310 3RD ST SW STE 2
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-5219
Practice Address - Country:US
Practice Address - Phone:540-815-7886
Practice Address - Fax:833-944-2522
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904004581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008954101Medicaid
VA800003020Medicare ID - Type Unspecified