Individual
IDA ROSE WADSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
206 4TH ST SW, FORT PAYNE, AL 35967-1851
(256) 304-5755
Mailing address
206 4TH ST SW, FORT PAYNE, AL 35967-1851
(256) 304-5755
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3953
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32053719
—
AL
Enumeration date
03/15/2018
Last updated
02/21/2021
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