Healthcare Provider Details

I. General information

NPI: 1295142826
Provider Name (Legal Business Name): ROSHAWN RENEE ADAMS CADC III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 GEORGIA ST
VALLEJO CA
94590-5905
US

IV. Provider business mailing address

1849 CLAY ST
FAIRFIELD CA
94533-3810
US

V. Phone/Fax

Practice location:
  • Phone: 707-558-8195
  • Fax: 707-558-8196
Mailing address:
  • Phone: 707-563-7272
  • Fax: 707-558-8196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberB00002810223
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: