Individual
MR. JONATHAN LEWIS WADE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.DIV.
Contact information
Practice address
5000 HILLTOP DR, BROOKHAVEN, PA 19015-1228
(484) 490-1060
(610) 876-4534
Mailing address
201 BLACKWOOD CLEMENTON RD, APT. 1901, LINDENWOLD, NJ 08021-6878
(609) 562-3992
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
Other
Enumeration date
10/22/2012
Last updated
10/22/2012
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