| NPI | 1699769737 |
|---|---|
| Former Name | GLENDA SUSAN WADE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AZ LMFT 0128) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA MFC 28,156) |
| Enumeration Date | 2005-09-05 |
| Last Update Date | 2007-07-08 |