Provider Demographics
NPI:1427240027
Name:WADE, HELOISA SANTOS (MFT)
Entity type:Individual
Prefix:MRS
First Name:HELOISA
Middle Name:SANTOS
Last Name:WADE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:HELOISA
Other - Middle Name:SANTOS
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:3045 KELLY ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541
Mailing Address - Country:US
Mailing Address - Phone:510-677-6025
Mailing Address - Fax:
Practice Address - Street 1:3045 KELLY ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:510-677-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT48986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427240027Medicaid