Individual provider Active NPI

Lakeysa Marie Wright, LISW-CP

  • Clinical Social Worker
  • Conway, SC
National Provider Identifier
1215201470
Registry record updated Jun 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
7334 Issued in SC
Practice address
314A Laurel St
Conway, SC 29526-5157
Phone
(843) 279-0172
Fax
(843) 438-4386
NPI assigned
Mar 5, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904007841 VA
Clinical Social Worker 1041C0700X 7334 SC Primary

Addresses

Primary practice location

314A Laurel St
Conway, SC 29526-5157

Mailing address

755 Burcale Rd Apt F7
Myrtle Beach, SC 29579-8315
Phone (945) 201-1878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904007841VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Waccamaws Health and Wellness Services LLC Clinical CurrentSince Jan 10, 2013 Accepting new patients

Locations

1119 3rd Ave
Conway, SC 29526
Phone (803) 394-7850

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1215201470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 BURCALE RD APT F7",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295798315",
            "telephone_number": "945-201-1878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314A LAUREL ST",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295265157",
            "telephone_number": "843-279-0172",
            "fax_number": "843-438-4386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRIGHT",
        "first_name": "LAKEYSA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "LISW-CP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-05",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904007841",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "7334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.