Provider Demographics
NPI:1457662751
Name:WADE, LISA COMBS
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:COMBS
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MEDICAL CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9421
Mailing Address - Country:US
Mailing Address - Phone:606-435-7200
Mailing Address - Fax:606-435-7201
Practice Address - Street 1:102 MEDICAL CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9421
Practice Address - Country:US
Practice Address - Phone:606-435-7200
Practice Address - Fax:606-435-7201
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor