Provider Demographics
NPI:1003795030
Name:WADE, THERESA LYNN
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 S JEFFERSON ST APT F8
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3188
Mailing Address - Country:US
Mailing Address - Phone:478-278-0409
Mailing Address - Fax:
Practice Address - Street 1:1606 S JEFFERSON ST APT F8
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3188
Practice Address - Country:US
Practice Address - Phone:478-278-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst