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General NPI Number Information
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NPI Number | 1679944979
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Entity Type | Individual
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Provider Name | HARRIETTE RAYSHEEN WADE MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 1112 E ASCENSION COMPLEX BLVD
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City | GONZALES
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State | LA
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Zip | 70737-4265
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Country | US
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Telephone | 225-743-2445
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Fax | 225-450-1150
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Provider Business Mailing Address
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Address Line | 5959 S SHERWOOD FOREST BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70816-6038
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Country | US
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Telephone | 225-743-2445
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Fax | 225-765-9196
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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 | 5750
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License Number State | LA
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