Provider Demographics
NPI:1851511497
Name:WADE, KENNETH J (LPC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:WADE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 HIGHLAND AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1408
Mailing Address - Country:US
Mailing Address - Phone:205-933-3695
Mailing Address - Fax:205-933-1836
Practice Address - Street 1:3100 HIGHLAND AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1408
Practice Address - Country:US
Practice Address - Phone:205-933-3695
Practice Address - Fax:205-933-1836
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL461101YM0800X
AL119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist