=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891469508
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WADE LINDSAY CHARTIER MA LADC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2021
-----------------------------------------------------
Last Update Date | 08/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 NOANK LEDYARD RD UNIT 12
-----------------------------------------------------
City | MYSTIC
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06355-1361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-227-6092
-----------------------------------------------------
Fax | 860-850-1031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 ROGERS LAKE TRL
-----------------------------------------------------
City | LYME
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06371-1239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-227-6092
-----------------------------------------------------
Fax | 860-850-1031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ALCOHOL AND DRUG COUNSELOR
-----------------------------------------------------
Name | MRS. WADE LINDSAY CHARTIER
-----------------------------------------------------
Credential | LADC
-----------------------------------------------------
Telephone | 860-227-6092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------