Provider Demographics
NPI:1801309414
Name:WADE, AMY (MA, LPC, NCC, CTT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:MA, LPC, NCC, CTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6710
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-233-4435
Mailing Address - Fax:304-233-4436
Practice Address - Street 1:2204 EOFF STREET
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-233-4435
Practice Address - Fax:304-233-4436
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional