Provider Demographics
NPI:1376201798
Name:WADE WELLNESS CENTER
Entity Type:Organization
Organization Name:WADE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-872-5048
Mailing Address - Street 1:200 N 13TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-4680
Mailing Address - Country:US
Mailing Address - Phone:903-872-5048
Mailing Address - Fax:903-875-0572
Practice Address - Street 1:200 N 13TH ST STE 205
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4680
Practice Address - Country:US
Practice Address - Phone:903-872-5048
Practice Address - Fax:903-875-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty