Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 39001836A | IN |
NPI | 1003024431 |
---|---|
Provider Name | Virginia M Adams |
First Address | Fort Wayne, IN 46815-6628 |
Second Address | Angola, IN 46703-9349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |