Provider Demographics
NPI:1194923656
Name:WADE, TERENCE CLIFFORD (PHD)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:CLIFFORD
Last Name:WADE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 BISHOP STREET
Mailing Address - Street 2:SUITE 3205
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3313
Mailing Address - Country:US
Mailing Address - Phone:808-545-7706
Mailing Address - Fax:413-812-4219
Practice Address - Street 1:1188 BISHOP STREET
Practice Address - Street 2:SUITE 3205
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3313
Practice Address - Country:US
Practice Address - Phone:808-545-7706
Practice Address - Fax:413-812-4219
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05365701Medicaid
HI2911OtherALOHA CARE
HIPSY161OtherHMAA, MDX
HI0000061655OtherHMSA BLUE CROSS
HI9911634OtherUHA
HI208654OtherSUMMERLIN, HMA, HMN
HI9911634OtherUHA
HIS30328Medicare UPIN