Basic Information
| Provider Information | |||||||||
| NPI: | 1629430277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WADE | ||||||||
| FirstName: | COURTNEY | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5528 ECHO RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432301105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409737827 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1142 S HIGH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432063467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148271307 | ||||||||
| FaxNumber: | 6142670145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2016 | ||||||||
| LastUpdateDate: | 12/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | C1400004 | OH | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | E.1800783 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.