Individual
DEIANDRA SHANEYCE WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCA
Contact information
Practice address
3409 W WENDOVER AVE STE I, GREENSBORO, NC 27407-1579
(336) 897-2375
Mailing address
1311 ELMER ST, GREENSBORO, NC 27405-5801
(336) 324-6333
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A13096
NC
Other
Enumeration date
04/06/2018
Last updated
04/06/2018
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