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Individual

MARY TATE THOMAS WADE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ALC, MA

Contact information

Practice address
400 OFFICE PARK DR, MOUNTAIN BRK, AL 35223-3408
(205) 730-6217
Mailing address
2604 DENYSE DR, BIRMINGHAM, AL 35243-4101
(205) 862-2603

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
ALC04259
AL

Other

Enumeration date
10/03/2022
Last updated
10/19/2022
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