Provider Demographics
NPI:1518243922
Name:WADE, BILLY JR (LCSW)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:WADE
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 S HYDE PARK BLVD
Mailing Address - Street 2:APT. 711
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4245
Mailing Address - Country:US
Mailing Address - Phone:773-324-2413
Mailing Address - Fax:
Practice Address - Street 1:5242 S HYDE PARK BLVD
Practice Address - Street 2:APT. 711
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4245
Practice Address - Country:US
Practice Address - Phone:773-324-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-30
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490132651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical