Healthcare Provider Details

I. General information

NPI: 1033588454
Provider Name (Legal Business Name): VICKI ADAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26176 MELBA AVE
HOMELAND CA
92548-9306
US

IV. Provider business mailing address

26176 MELBA AVE
HOMELAND CA
92548-9306
US

V. Phone/Fax

Practice location:
  • Phone: 951-219-1975
  • Fax:
Mailing address:
  • Phone: 951-219-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: