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General NPI Number Information
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NPI Number | 1770059768
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Entity Type | Organization
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Legal Business Name | HOLLY WADE LCSW LLC
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 2201 DAYTON BLVD
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City | CHATTANOOGA
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State | TN
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Zip | 37415-6415
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Country | US
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Telephone | 203-918-0336
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Fax |
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Provider Business Mailing Address
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Address Line | 151 INTEGRA VISTAS DR APT 306
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City | HIXSON
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State | TN
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Zip | 37343-5378
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Country | US
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Telephone | 203-918-0336
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | HOLLY E WADE
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Credential | LCSW
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Telephone | 203-918-0336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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