Provider Demographics
NPI:1932651965
Name:WADE, DEBRA (CADC LL)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:CADC LL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4012
Mailing Address - Country:US
Mailing Address - Phone:951-686-0021
Mailing Address - Fax:951-686-0026
Practice Address - Street 1:4750 PALM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4012
Practice Address - Country:US
Practice Address - Phone:951-686-0021
Practice Address - Fax:951-686-0021
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAA060641121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)