Healthcare Provider Details

I. General information

NPI: 1326354143
Provider Name (Legal Business Name): YOLANDA DENICE MCDADE LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 24TH PL
MERIDIAN MS
39305-1686
US

IV. Provider business mailing address

4715 24TH PL
MERIDIAN MS
39305-1686
US

V. Phone/Fax

Practice location:
  • Phone: 601-581-7562
  • Fax: 601-581-7676
Mailing address:
  • Phone: 601-696-6736
  • Fax: 601-696-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1476
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: