Healthcare Provider Details

I. General information

NPI: 1831549211
Provider Name (Legal Business Name): MELISSA ANN ADAMS LMSW-CC, LADC, CCS,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SPRUCE ST
AUGUSTA ME
04330-5213
US

IV. Provider business mailing address

9 SPRUCE ST
AUGUSTA ME
04330-5213
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-7218
  • Fax:
Mailing address:
  • Phone: 207-621-7218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC5332
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCCS5580
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC14076
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC14076
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: