Provider Demographics
NPI:1366151482
Name:WADE, CARLA NEELY (LSW, MA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:NEELY
Last Name:WADE
Suffix:
Gender:F
Credentials:LSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-1451
Mailing Address - Country:US
Mailing Address - Phone:304-455-3035
Mailing Address - Fax:304-455-3036
Practice Address - Street 1:754 3RD ST
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1451
Practice Address - Country:US
Practice Address - Phone:304-455-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health