Provider Demographics
NPI:1760880504
Name:WADE, HOLLY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:WADE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:WADE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:275 CUMBERLAND BND
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1805
Mailing Address - Country:US
Mailing Address - Phone:615-726-3340
Mailing Address - Fax:615-743-1679
Practice Address - Street 1:801 N HOLTZCLAW AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1236
Practice Address - Country:US
Practice Address - Phone:423-697-5953
Practice Address - Fax:615-743-1679
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0088341041C0700X
TN61381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical