Healthcare Provider Details

I. General information

NPI: 1205713377
Provider Name (Legal Business Name): DANIELLE WADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N UNION ST STE 100
ALEXANDRIA VA
22314-2643
US

IV. Provider business mailing address

400 S COLORADO BLVD STE 590
GLENDALE CO
80246-1252
US

V. Phone/Fax

Practice location:
  • Phone: 240-262-0390
  • Fax: 866-421-4317
Mailing address:
  • Phone: 240-266-0952
  • Fax: 866-421-4317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016422
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: