Healthcare Provider Details

I. General information

NPI: 1861159154
Provider Name (Legal Business Name): MARY-CATHERINE E WADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY WADE

II. Dates (important events)

Enumeration Date: 11/21/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10498 NOBLETON RD
APPLE VALLEY CA
92308-3307
US

IV. Provider business mailing address

10498 NOBLETON RD
APPLE VALLEY CA
92308-3307
US

V. Phone/Fax

Practice location:
  • Phone: 909-963-4731
  • Fax:
Mailing address:
  • Phone: 909-963-4731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: