Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 964492 | OH |
N | 101YP1600X | Pastoral Counselor | 100761 | OH |
NPI | 1043740079 |
---|---|
Provider Name | Ms. Charlene Jeanette Adams |
First Address | Sandusky, OH 44870-3038 |
Second Address | Sandusky, OH 44870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2017 |
Last Update Date | 13/06/2017 |