Individual
CAROLINE DENISE WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCA
Contact information
Practice address
1638 SE 12TH AVE APT 213, PORTLAND, OR 97214-4777
(323) 383-2345
Mailing address
1638 SE 12TH AVE APT 213, PORTLAND, OR 97214-4777
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
R8119
OR
101YM0800X
Mental Health Counselor
Primary
R8119
OR
101YP2500X
Professional Counselor
R81199
OR
Other
Enumeration date
02/01/2023
Last updated
02/01/2023
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