Healthcare Provider Details

I. General information

NPI: 1497202873
Provider Name (Legal Business Name): MELISSA WADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 MOUNT OLIVET RD NE SPRING ACADEMY
WASHINGTON DC
20002-2509
US

IV. Provider business mailing address

1375 MOUNT OLIVET RD NE SPRING ACADEMY
WASHINGTON DC
20002-2509
US

V. Phone/Fax

Practice location:
  • Phone: 202-465-2485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC50080692
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: