Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003054230 |
---|---|
Provider Name | Dustin Adams |
First Address | Ackerman, MS 39735-6600 |
Second Address | Starkville, MS 39759-2504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2009 |
Last Update Date | 26/01/2009 |