Healthcare Provider Details

I. General information

NPI: 1013636166
Provider Name (Legal Business Name): DESTINY M ADAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DESTINEY ADAMS LCSW

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NE MCCLAIN RD STE 2
BENTONVILLE AR
72712-3888
US

IV. Provider business mailing address

1400 NE MCCLAIN RD STE 2
BENTONVILLE AR
72712-3888
US

V. Phone/Fax

Practice location:
  • Phone: 479-657-6636
  • Fax:
Mailing address:
  • Phone: 479-657-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10343-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: