Provider Demographics
NPI:1790121879
Name:WADE, MARCIA
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
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 1:1181/2 N WOODLAN BLVD
Mailing Address - Street 2:SUIT 2
Mailing Address - City:DELAN
Mailing Address - State:FL
Mailing Address - Zip Code:32720
Mailing Address - Country:US
Mailing Address - Phone:386-734-6555
Mailing Address - Fax:
Practice Address - Street 1:118 N WOODLAND BLVD
Practice Address - Street 2:SUIT
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-4217
Practice Address - Country:US
Practice Address - Phone:386-734-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health