Provider Demographics
NPI:1912402546
Name:WADE, BEVERLY (MMFT, LMFT)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:MMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N LANFORD RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-2872
Mailing Address - Country:US
Mailing Address - Phone:864-909-5178
Mailing Address - Fax:
Practice Address - Street 1:101 N PINE ST STE 414B
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1604
Practice Address - Country:US
Practice Address - Phone:864-909-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist