Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor |
NPI | 1063640332 |
---|---|
Provider Name | Dionne Wade |
First Address | Garland, TX 75049-4674 |
Second Address | Garland, TX 75043-3836 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 06/02/2017 |