Provider Demographics
NPI:1164735544
Name:WADLEY, MELEIKA A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELEIKA
Middle Name:A
Last Name:WADLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21253 N 36TH PL
Mailing Address - Street 2:PHOENIX AZ
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8388
Mailing Address - Country:US
Mailing Address - Phone:216-659-8109
Mailing Address - Fax:
Practice Address - Street 1:21253 N 36TH PL
Practice Address - Street 2:PHOENIX AZ
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-8388
Practice Address - Country:US
Practice Address - Phone:216-659-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-153061041S0200X
OHI. 12008911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical