Doctor Name: | SHANITA WADE |
NPI Number: | 1265737951 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 6401010998 |
Business Practice Address: | 4287 Five Oaks Dr Lansing, MI - 489114214 |
Business Phone Number: | 5178824000 |
Business Fax Number: | 5178823506 |
Mailing Address: | 4287 Five Oaks Dr, LANSING |
State: | MI |
Postal Code: | 489114214 |
Phone Number: | 5178824000 |
Fax Number: | 5178823506 |
NPI Enumeration Date: | 01/11/2011 |
NPI Last Update Date: | 01/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 6401010998 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |