Provider Demographics
NPI:1740577881
Name:WADE, YVETTE DARLENE
Entity Type:Individual
Prefix:MS
First Name:YVETTE
Middle Name:DARLENE
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6266 BETH PAGE DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1229
Mailing Address - Country:US
Mailing Address - Phone:213-200-0535
Mailing Address - Fax:
Practice Address - Street 1:2085 RUSTIN AVE STE 5
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2498
Practice Address - Country:US
Practice Address - Phone:951-509-2400
Practice Address - Fax:951-509-2405
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
CA894521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health