Provider Demographics
NPI:1598406175
Name:WADE, NYAA-SIMONE (MA)
Entity Type:Individual
Prefix:MISS
First Name:NYAA-SIMONE
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5945
Mailing Address - Country:US
Mailing Address - Phone:781-956-6932
Mailing Address - Fax:
Practice Address - Street 1:1605 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-1801
Practice Address - Country:US
Practice Address - Phone:804-644-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health