Individual
LEE TYSON WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1205 BAYTREE ROAD, #8, VALDOSTA, GA 31602
(229) 244-5533
(229) 253-9066
Mailing address
1205 BAYTREE ROAD, #8, VALDOSTA, GA 31602
(229) 244-5533
(229) 253-9066
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
07/02/2012
Last updated
07/02/2012
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