Individual
SHANITA WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
411 W LAKE LANSING RD STE A100, EAST LANSING, MI 48823-8404
(517) 798-3717
Mailing address
PO BOX 10, MASON, MI 48854-0010
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401017983
MI
Other
Enumeration date
01/11/2011
Last updated
03/29/2023
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