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Individual
MARILYN WRIGHT WADE
Active
Individual
MARILYN WRIGHT WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC, MISA I
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
3
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
30991
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568509719
—
IL
Enumeration date
12/26/2018
Last updated
12/26/2018
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