MEDICARE: ZOE SAMIRA WADE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	010806	GA
2	101YP2500X	Professional Counselor	LPC010806	GA

General Provider Information

NPI Number	:	1447717277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOE SAMIRA WADE LPC

Provider Business Mailing Address
First Line	:	310 PRESTMOOR PL SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-7655
Country	:	US
Telephone Number	:	404-804-2825
Fax Number	:

Provider Business Practice Location Address
First Line	:	6595 ROSWELL RD STE G6048
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3152
Country	:	US
Telephone Number	:	470-652-0423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	01/05/2024

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