Basic Information
| Provider Information | |||||||||
| NPI: | 1003146564 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | LISW-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4419 DEEDS RD SW | ||||||||
| Address2: | |||||||||
| City: | PATASKALA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430627447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404041339 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 905 RIVER RD STE A | ||||||||
| Address2: | |||||||||
| City: | GRANVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430239560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405872822 | ||||||||
| FaxNumber: | 7405872822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2010 | ||||||||
| LastUpdateDate: | 01/06/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | I. 0600081 SUPV | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.