Organization
CHANGE YOUR REALITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD ALAN WADE THERAPIST (CEO)
(803) 530-0510
Entity
Organization
Contact information
Practice address
729 TRUE ST APT 3, COLUMBIA, SC 29209-1659
(803) 530-0510
Mailing address
729 TRUE ST APT 3, COLUMBIA, SC 29209-1659
(803) 530-0510
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/08/2019
Last updated
03/08/2019
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