Provider Demographics
NPI:1306510755
Name:WADE, JULIANA ELISE (LPC)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:ELISE
Last Name:WADE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BROCKMAN DR
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2312
Mailing Address - Country:US
Mailing Address - Phone:803-767-7195
Mailing Address - Fax:
Practice Address - Street 1:880 S PLEASANTBURG DR STE 4F
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2453
Practice Address - Country:US
Practice Address - Phone:864-735-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health