Healthcare Provider Details

I. General information

NPI: 1336973171
Provider Name (Legal Business Name): ANDREW WADE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 DUEBER AVE SW
CANTON OH
44706-1210
US

IV. Provider business mailing address

101 PEMBROKE CT
GREENSBURG PA
15601-6404
US

V. Phone/Fax

Practice location:
  • Phone: 724-396-1510
  • Fax: 724-972-4672
Mailing address:
  • Phone: 724-396-1510
  • Fax: 724-972-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507559
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: