Individual
MR. WADE MIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAS-A
Contact information
Practice address
1480 MAPLE GROVE CHURCH RD, DUNN, NC 28334-7692
(910) 567-7155
Mailing address
3331 EASY ST, DUNN, NC 28334-7988
(910) 567-7067
(910) 567-5552
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
23170
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01
N/A
NC
05
—
1427087709
—
NC
Enumeration date
12/06/2018
Last updated
12/06/2018
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