Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 28745 | TX |
NPI | 1003189457 |
---|---|
Provider Name | Stacey Adams |
First Address | San Antonio, TX 78229-4404 |
Second Address | San Antonio, TX 78229-4404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2012 |
Last Update Date | 15/02/2012 |