Basic Information
| Provider Information | |||||||||
| NPI: | 1104194091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW, CADC, CODP I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 534 1ST ST STE A | ||||||||
| Address2: | |||||||||
| City: | CRETE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604172153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084203210 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8020 W 87TH ST | ||||||||
| Address2: | |||||||||
| City: | HICKORY HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604571189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087455277 | ||||||||
| FaxNumber: | 7087414501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2011 | ||||||||
| LastUpdateDate: | 11/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 24994 | IL | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.