Provider Demographics
NPI:1902939804
Name:WADE-HAMPTON, VERONICA (MS, LPC-MHSP, NCC)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:WADE-HAMPTON
Suffix:
Gender:F
Credentials:MS, LPC-MHSP, NCC
Other - Prefix:MS
Other - First Name:VERONICA
Other - Middle Name:B
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4265 VALLEY GLYNN DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3204
Mailing Address - Country:US
Mailing Address - Phone:901-375-4433
Mailing Address - Fax:901-375-4433
Practice Address - Street 1:5830 MOUNT MORIAH RD
Practice Address - Street 2:SUITE 20
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1607
Practice Address - Country:US
Practice Address - Phone:901-244-6182
Practice Address - Fax:901-244-6258
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0906033101YP2500X
TNLPC0000002465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional