Healthcare Provider Details

I. General information

NPI: 1780114009
Provider Name (Legal Business Name): JULIE ROSE ADAMS M.A., NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 TOWN ST
NORWICH CT
06360-2323
US

IV. Provider business mailing address

47 TOWN ST
NORWICH CT
06360-2323
US

V. Phone/Fax

Practice location:
  • Phone: 860-892-7042
  • Fax:
Mailing address:
  • Phone: 860-822-4778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002920
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: