Provider Demographics
NPI:1184366403
Name:WADE, LARAE A (LICSW-S)
Entity type:Individual
Prefix:
First Name:LARAE
Middle Name:A
Last Name:WADE
Suffix:
Gender:
Credentials:LICSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9032 MEMORIAL PARKWAY, SUITE A
Mailing Address - Street 2:#1012
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3013
Mailing Address - Country:US
Mailing Address - Phone:256-658-3430
Mailing Address - Fax:
Practice Address - Street 1:190 LIME QUARRY RD SUITE 107
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8975
Practice Address - Country:US
Practice Address - Phone:256-862-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5304C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical