Individual
MARY C WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., LPC
Contact information
Practice address
85 GOLF CREST DR, SUITE 309, ACWORTH, GA 30101-2698
(404) 480-0430
Mailing address
160 RIDGEWOOD WAY, DALLAS, GA 30132-2684
(404) 480-0430
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC007481
GA
101YS0200X
School Counselor
462269
GA
Other
Enumeration date
02/12/2014
Last updated
04/01/2021
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