Healthcare Provider Details

I. General information

NPI: 1639533045
Provider Name (Legal Business Name): DAVID RONALD ADAMS JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24445 NORTHWESTERN HWY
SOUTHFIELD MI
48075-6501
US

IV. Provider business mailing address

24445 NORTHWESTERN HWY
SOUTHFIELD MI
48075-6501
US

V. Phone/Fax

Practice location:
  • Phone: 248-483-7804
  • Fax:
Mailing address:
  • Phone: 248-483-7804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018779
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401018779
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: