Healthcare Provider Details

I. General information

NPI: 1316161383
Provider Name (Legal Business Name): VIOLET LOREE ADAMS L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W FRONT ST SUITE 400A
BLOOMINGTON IL
61701-5048
US

IV. Provider business mailing address

1712 ROCKINGHAM DR APT 5
NORMAL IL
61761-4758
US

V. Phone/Fax

Practice location:
  • Phone: 309-828-2860
  • Fax: 308-827-2637
Mailing address:
  • Phone: 309-451-3706
  • Fax: 309-827-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: