Healthcare Provider Details

I. General information

NPI: 1578226841
Provider Name (Legal Business Name): SHANA WATKINS ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 MILL ST
CAMDEN SC
29020-4738
US

IV. Provider business mailing address

1663A MCBEE HWY
JEFFERSON SC
29718-9452
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-6902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: