Healthcare Provider Details

I. General information

NPI: 1861363947
Provider Name (Legal Business Name): KYLE WAYNE ADAMSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 SONOMA HWY STE B
SANTA ROSA CA
95409-4165
US

IV. Provider business mailing address

PO BOX 108
FULTON CA
95439-0108
US

V. Phone/Fax

Practice location:
  • Phone: 707-327-0909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC19948
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT156235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: