Provider Demographics
NPI:1417230038
Name:WADE, DONNA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:WADE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 WINDCLIFF DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8353
Mailing Address - Country:US
Mailing Address - Phone:404-938-4517
Mailing Address - Fax:404-938-4517
Practice Address - Street 1:5696 PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2855
Practice Address - Country:US
Practice Address - Phone:404-938-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006497101YP2500X
OHLPC600201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional