Provider Demographics
NPI:1629216015
Name:CARVER, WADE R (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:R
Last Name:CARVER
Suffix:
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 GIBSON BLVD SE STE 13
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-5182
Mailing Address - Country:US
Mailing Address - Phone:505-383-1165
Mailing Address - Fax:505-383-1191
Practice Address - Street 1:5400 GIBSON BLVD SE STE 13
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5182
Practice Address - Country:US
Practice Address - Phone:505-383-1165
Practice Address - Fax:505-383-1191
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-08521041C0700X, 104100000X
NM2004101YA0400X
MI680108111101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker