Individual
TINA C. WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1303 E ALAMO ST, BRENHAM, TX 77833-3823
(979) 661-4664
Mailing address
PO BOX 1765, BRENHAM, TX 77834-1765
(979) 661-4664
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/15/2009
Last updated
01/15/2009
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