Healthcare Provider Details

I. General information

NPI: 1790121879
Provider Name (Legal Business Name): MARCIA WADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N WOODLAND BLVD SUIT
DELAND FL
32720-4217
US

IV. Provider business mailing address

1181/2 N WOODLAN BLVD SUIT 2
DELAN FL
32720
US

V. Phone/Fax

Practice location:
  • Phone: 386-734-6555
  • Fax:
Mailing address:
  • Phone: 386-734-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: