Provider Demographics
NPI:1619450368
Name:WADE, MELANIE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5003
Mailing Address - Country:US
Mailing Address - Phone:304-723-5440
Mailing Address - Fax:
Practice Address - Street 1:201 EDGINGTON LN
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-1513
Practice Address - Country:US
Practice Address - Phone:304-242-0217
Practice Address - Fax:304-242-0218
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600269104100000X
WVDP009447631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical