Healthcare Provider Details

I. General information

NPI: 1245620491
Provider Name (Legal Business Name): CAITLIN MINOR ADAMS LCMHC; LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 NORTHWEST LN
WARRENSVILLE NC
28693-9244
US

IV. Provider business mailing address

PO BOX 208
JEFFERSON NC
28640-0208
US

V. Phone/Fax

Practice location:
  • Phone: 336-246-9449
  • Fax: 336-384-1626
Mailing address:
  • Phone: 336-246-9449
  • Fax: 336-982-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11388
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21391
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: