Provider Demographics
NPI:1780930768
Name:WADE, MARCUS L (LMSW/LCDC)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:L
Last Name:WADE
Suffix:
Gender:M
Credentials:LMSW/LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E FRONT ST STE 145
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8213
Mailing Address - Country:US
Mailing Address - Phone:903-372-0349
Mailing Address - Fax:903-472-5038
Practice Address - Street 1:401 E FRONT ST STE 145
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8213
Practice Address - Country:US
Practice Address - Phone:903-372-0349
Practice Address - Fax:903-472-5038
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10748101YA0400X
TX567491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)