Provider Demographics
NPI:1518482876
Name:WADE, DENNIS (MS, SUDCC IV-CS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:WADE
Suffix:
Gender:M
Credentials:MS, SUDCC IV-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4543
Mailing Address - Country:US
Mailing Address - Phone:530-621-6359
Mailing Address - Fax:530-295-2596
Practice Address - Street 1:929 SPRING ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4543
Practice Address - Country:US
Practice Address - Phone:530-621-6359
Practice Address - Fax:530-295-2596
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6084101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6084OtherCALIFORNIA ASSOCIATION OF DUI TREATMENT PROGRAMS