Active NPI
Mary C Wade, M.ED., LPC
- Professional Counselor
- Acworth, GA
National Provider Identifier
1902220825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC007481
- Practice address
- 85 Golf Crest Dr
Suite 309
Acworth, GA 30101-2698 - Phone
- (404) 480-0430
- NPI assigned
- Feb 12, 2014
- Last updated
- Apr 1, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC007481 | GA | Primary |
| School Counselor | 101YS0200X | 462269 | GA |
Addresses
Primary practice location
85 Golf Crest Dr
Suite 309
Acworth, GA 30101-2698
Mailing address
160 Ridgewood Way
Dallas, GA 30132-2684
Phone (404) 480-0430
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC007481 | GA | MD | Professional Counselor |
| 462269 | GA | MD | School Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617235200000",
"number": "1902220825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 RIDGEWOOD WAY",
"city": "DALLAS",
"state": "GA",
"postal_code": "301322684",
"telephone_number": "404-480-0430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 GOLF CREST DR",
"address_2": "SUITE 309",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301012698",
"telephone_number": "404-480-0430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "MARY",
"middle_name": "C",
"credential": "M.ED., LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-12",
"last_updated": "2021-04-01",
"certification_date": "2021-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC007481",
"primary": true
},
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": "GA",
"license": "462269",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.