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1972212561
IVY CHARLOTTE WADE
ARDMORE, OK
NPI
1972212561
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Additional Taxonomies
101YM0800X Counselor, Mental Health
Enumeration Date
2022-11-22
Last Update Date
2023-05-22
Business Address
IVY CHARLOTTE WADE
2530 S COMMERCE ST BLDG B
ARDMORE, OK 73401-5519
Phone number: 802-265-0485
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Mailing Address
IVY CHARLOTTE WADE
2530 S COMMERCE ST BLDG C
ARDMORE, OK 73401-5519
Phone number: 580-226-5048
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