Healthcare Provider Details

I. General information

NPI: 1164098372
Provider Name (Legal Business Name): CHRISTINE ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N DUKE ST UNIT 1094
DURHAM NC
27704-1709
US

IV. Provider business mailing address

3600 NORTH DUKE STREET SUITE 1, #1094
DURHAM NC
27704-1427
US

V. Phone/Fax

Practice location:
  • Phone: 919-627-7504
  • Fax:
Mailing address:
  • Phone: 919-627-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP016215
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: