1881920072 NPI number — WADE GIRARD JONES LPCMH, LCDP, CADC

Table of content: WADE GIRARD JONES LPCMH, LCDP, CADC (NPI 1881920072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881920072 NPI number — WADE GIRARD JONES LPCMH, LCDP, CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
WADE
Provider Middle Name:
GIRARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCMH, LCDP, CADC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881920072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2015
Provider Second Line Business Mailing Address:
1003 HOUSTON ACRES
Provider Business Mailing Address City Name:
MILLSBORO
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19966-8015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-542-3586
Provider Business Mailing Address Fax Number:
866-648-7571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 HOUSTON ACRES
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLSBORO
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19966-3568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-542-3586
Provider Business Practice Location Address Fax Number:
866-648-7571
Provider Enumeration Date:
10/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  PC-0000625 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: CD-0000050 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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