Healthcare Provider Details

I. General information

NPI: 1922525112
Provider Name (Legal Business Name): HOLLIS SELBY ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 N MAGNOLIA AVE STE 110
EL CAJON CA
92020-3610
US

IV. Provider business mailing address

2621 1ST AVE APT 3
SAN DIEGO CA
92103-6550
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-5133
  • Fax:
Mailing address:
  • Phone: 559-779-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: