Healthcare Provider Details

I. General information

NPI: 1033753314
Provider Name (Legal Business Name): WADE COUNSELING AND MENTORING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 SW 6TH ST
GRANTS PASS OR
97526-2406
US

IV. Provider business mailing address

232 SW 6TH ST
GRANTS PASS OR
97526-2406
US

V. Phone/Fax

Practice location:
  • Phone: 541-324-9186
  • Fax:
Mailing address:
  • Phone: 541-324-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KAREEM WADE
Title or Position: CEO
Credential: BIP, CPS, CADC I
Phone: 541-324-9186