MEDICARE: MS. AMBER SHARI GOLDWIRE-WADE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW005050	GA
2	101YM0800X	Mental Health Counselor	CSW005050	GA

General Provider Information

NPI Number	:	1295385730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMBER SHARI GOLDWIRE-WADE LCSW

Provider Business Mailing Address
First Line	:	2555 HARRISON MILL DR
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30135-4441
Country	:	US
Telephone Number	:	404-512-6822
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 CARPENTER DR
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4931
Country	:	US
Telephone Number	:	678-460-0345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	03/07/2026

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