Healthcare Provider Details

I. General information

NPI: 1629216015
Provider Name (Legal Business Name): WADE R. CARVER LCSW, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE STE 13
ALBUQUERQUE NM
87108-5182
US

IV. Provider business mailing address

5400 GIBSON BLVD SE STE 13
ALBUQUERQUE NM
87108-5182
US

V. Phone/Fax

Practice location:
  • Phone: 505-383-1165
  • Fax: 505-383-1191
Mailing address:
  • Phone: 505-383-1165
  • Fax: 505-383-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-0852
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2004
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number680108111
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2022-0852
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: