Healthcare Provider Details

I. General information

NPI: 1891435855
Provider Name (Legal Business Name): ASHLYN WADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WESLEYAN DR
MC ADENVILLE NC
28101-9013
US

IV. Provider business mailing address

315 WESLEYAN DR
MC ADENVILLE NC
28101-9013
US

V. Phone/Fax

Practice location:
  • Phone: 704-387-3587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: