Healthcare Provider Details

I. General information

NPI: 1528518321
Provider Name (Legal Business Name): DANA KIRKWOOD ADKINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 BEECH STREET BUILDING 949, ROOM #225
MCCLELLAN CA
95652
US

IV. Provider business mailing address

9848 OAKPLACE E
FOLSOM CA
95630-1918
US

V. Phone/Fax

Practice location:
  • Phone: 916-640-8454
  • Fax: 916-640-0995
Mailing address:
  • Phone: 916-988-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: