Provider Demographics
NPI:1730656216
Name:WADE, LAURA ANNA (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNA
Last Name:WADE
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 CALAPOOIA ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2563
Mailing Address - Country:US
Mailing Address - Phone:808-796-1632
Mailing Address - Fax:541-543-2480
Practice Address - Street 1:1335 CALAPOOIA ST SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2563
Practice Address - Country:US
Practice Address - Phone:458-201-3122
Practice Address - Fax:541-543-2480
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1960-17101YA0400X
CO0014984101YM0800X
ORC5888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)