Provider Demographics
NPI:1467264390
Name:WADE, SAMANTHA JAYDE (MSW)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JAYDE
Last Name:WADE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75124 WHITE RABBIT AVE
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-0115
Mailing Address - Country:US
Mailing Address - Phone:941-962-7806
Mailing Address - Fax:
Practice Address - Street 1:4427 EMERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4969
Practice Address - Country:US
Practice Address - Phone:941-962-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor