Provider Demographics
NPI:1841641511
Name:WADE, JASMINE DIAMOND (MA, LLPC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DIAMOND
Last Name:WADE
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:DIAMOND
Other - Last Name:BARTELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17250 PATTON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-4725
Mailing Address - Country:US
Mailing Address - Phone:248-773-2363
Mailing Address - Fax:
Practice Address - Street 1:17250 PATTON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4725
Practice Address - Country:US
Practice Address - Phone:248-773-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional