Provider Demographics
NPI:1265088538
Name:WADE, HUGH LOVE III (ED S)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:LOVE
Last Name:WADE
Suffix:III
Gender:M
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 CEDAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:VA
Mailing Address - Zip Code:24437-2063
Mailing Address - Country:US
Mailing Address - Phone:540-746-2190
Mailing Address - Fax:
Practice Address - Street 1:2055 COURTHOUSE ROAD
Practice Address - Street 2:MNES/ SCHOOL PSYC. OFFICE
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093
Practice Address - Country:US
Practice Address - Phone:540-967-1347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA331-945103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool