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General NPI Number Information
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NPI Number | 1376201798
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Entity Type | Organization
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Legal Business Name | WADE WELLNESS CENTER
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 200 N 13TH ST STE 205
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City | CORSICANA
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State | TX
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Zip | 75110-4680
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Country | US
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Telephone | 903-872-5048
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Fax | 903-875-0572
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Provider Business Mailing Address
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Address Line | 200 N 13TH ST STE 205
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City | CORSICANA
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State | TX
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Zip | 75110-4680
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Country | US
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Telephone | 903-872-5048
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Fax | 903-875-0572
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DAPHNEE YOUNG
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Credential |
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Telephone | 903-872-5048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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