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General NPI Number Information
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NPI Number | 1912402546
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Entity Type | Individual
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Provider Name | BEVERLY WADE MMFT, LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 101 N PINE ST STE 414B
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City | SPARTANBURG
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State | SC
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Zip | 29302-1604
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Country | US
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Telephone | 864-909-5178
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Fax |
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Provider Business Mailing Address
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Address Line | 224 N LANFORD RD
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City | SPARTANBURG
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State | SC
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Zip | 29301-2872
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Country | US
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Telephone | 864-909-5178
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4691
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License Number State | SC
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