MEDICARE: RANDA ADAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	P0810080	AR
3	101YP2500X	Professional Counselor	LPC011736	GA

General Provider Information

NPI Number	:	1760632996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDA ADAMS

Provider Business Mailing Address
First Line	:	1511 JOHNSON FERRY RD STE 125
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-6403
Country	:	US
Telephone Number	:	770-835-5682
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 JOHNSON FERRY RD STE 125
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-6403
Country	:	US
Telephone Number	:	770-835-5682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	09/20/2023

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Directions to “ RANDA ADAMS ” Practice Location

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