Healthcare Provider Details

I. General information

NPI: 1679944979
Provider Name (Legal Business Name): HARRIETTE RAYSHEEN WADE MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E ASCENSION COMPLEX BLVD
GONZALES LA
70737-4265
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-743-2445
  • Fax: 225-450-1150
Mailing address:
  • Phone: 225-743-2445
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5750
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: