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General NPI Number Information
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NPI Number | 1417230038
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Entity Type | Individual
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Provider Name | DONNA MARIE WADE LPC
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Gender | Female
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 5696 PEACHTREE PKWY
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City | NORCROSS
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State | GA
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Zip | 30092-2855
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Country | US
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Telephone | 404-938-4517
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Fax |
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Provider Business Mailing Address
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Address Line | 517 WINDCLIFF DR SE
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City | MARIETTA
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State | GA
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Zip | 30067-8353
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Country | US
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Telephone | 404-938-4517
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Fax | 404-938-4517
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LPC006497
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC600201
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License Number State | OH
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