Healthcare Provider Details

I. General information

NPI: 1902939804
Provider Name (Legal Business Name): VERONICA WADE-HAMPTON M.S., LPC-MHSP, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VERONICA B WADE M.S.

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 MOUNT MORIAH RD SUITE 20
MEMPHIS TN
38115-1607
US

IV. Provider business mailing address

4265 VALLEY GLYNN DR
MEMPHIS TN
38125-3204
US

V. Phone/Fax

Practice location:
  • Phone: 901-244-6182
  • Fax: 901-244-6258
Mailing address:
  • Phone: 901-375-4433
  • Fax: 901-375-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0906033
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC0000002465
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: