Individual
IVY CHARLOTTE WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2530 S COMMERCE ST BLDG B, ARDMORE, OK 73401-5519
(802) 265-0485
(580) 226-3569
Mailing address
2530 S COMMERCE ST BLDG C, ARDMORE, OK 73401-5519
(580) 226-5048
(580) 226-3569
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/22/2022
Last updated
05/22/2023
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