Individual
DIEDRE L WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. LPCC
Contact information
Practice address
130 FAIRFAX AVE, SUITE 100B, LOUISVILLE, KY 40207-4939
(502) 512-0133
Mailing address
130 FAIRFAX AVE, SUITE 100B, LOUISVILLE, KY 40207-4939
(502) 512-0133
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PROCOUPCC00211336
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100345050
—
KY
Enumeration date
10/30/2012
Last updated
04/29/2016
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