Individual
LONNIE LEWIS WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1035 CHERAW STREET, BENNETTSVILLE, SC 29512
(843) 454-0841
Mailing address
PO BOX 918, BENNETTSVILLE, SC 29512
(843) 454-0841
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405127
—
SC
Enumeration date
12/18/2015
Last updated
08/08/2019
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