Provider Demographics
NPI:1013773050
Name:WARDEN, WADE (RMHCI, NCC)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:WARDEN
Suffix:
Gender:M
Credentials:RMHCI, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 RIO DE JANEIRO AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-8662
Mailing Address - Country:US
Mailing Address - Phone:941-249-3124
Mailing Address - Fax:
Practice Address - Street 1:2186 RIO DE JANEIRO AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-8662
Practice Address - Country:US
Practice Address - Phone:941-249-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH23222101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health