Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Raevin Ashley Wade

Individual provider Clinical Social Worker · NPI 1053249763

Raevin Ashley Wade is a Clinical Social Worker in Hattiesburg, Mississippi. Qualified in 2022, 4 years ago. Works from 2 locations. Licensed in Mississippi.

Years since qualifying
4
Licensed in
MS
In the registry since
2026
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Practice location Address checks out

525 N Main St Fl 3
Hattiesburg, MS 39401-3582
Phone: (601) 699-4080
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 29 Park Pl, Hattiesburg, MS 39402-1560 — (601) 433-0802

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence C12013 (MS)

Record details

NPI number1053249763
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMay 12, 2026
Last updated in NPPESMay 12, 2026
Certification dateMay 12, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Hattiesburg