Provider Demographics
NPI:1700104106
Name:WADE, HOLLY R (LCPC, LPC)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:R
Last Name:WADE
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15394 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:NEW FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:17349-9085
Mailing Address - Country:US
Mailing Address - Phone:443-904-2715
Mailing Address - Fax:
Practice Address - Street 1:15394 REVERE DR
Practice Address - Street 2:
Practice Address - City:NEW FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:17349-9085
Practice Address - Country:US
Practice Address - Phone:443-904-2715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3484101YP2500X
PAPC010486101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional