MEDICARE: ANGELA MARIE WADE ALC

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	101Y00000X	Counselor	822268	AL

General Provider Information

NPI Number	:	1649997396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE WADE ALC

Provider Business Mailing Address
First Line	:	215 GRAND AVE SW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-1917
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 GRAND AVE SW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-1917
Country	:	US
Telephone Number	:	256-509-0504
Fax Number	:

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

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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