Provider Demographics
NPI:1366795890
Name:WADE, JONATHAN LEWIS SR (MDIV)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:LEWIS
Last Name:WADE
Suffix:SR
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BLACKWOOD CLEMENTON RD
Mailing Address - Street 2:APT. 1901
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-6878
Mailing Address - Country:US
Mailing Address - Phone:609-562-3992
Mailing Address - Fax:
Practice Address - Street 1:5000 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-1228
Practice Address - Country:US
Practice Address - Phone:484-490-1060
Practice Address - Fax:610-876-4534
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral