Healthcare Provider Details

I. General information

NPI: 1306029079
Provider Name (Legal Business Name): MARY L ADAMS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31805 MIDDLEBELT RD SUITE 301
FARMINGTON HILLS MI
48334-2367
US

IV. Provider business mailing address

31805 MIDDLEBELT RD SUITE 301
FARMINGTON HILLS MI
48334-2367
US

V. Phone/Fax

Practice location:
  • Phone: 248-865-1164
  • Fax:
Mailing address:
  • Phone: 248-865-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801019405
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: