Healthcare Provider Details

I. General information

NPI: 1811622608
Provider Name (Legal Business Name): REBECCA JEAN ADKINS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 QUARRIER ST
CHARLESTON WV
25301-2338
US

IV. Provider business mailing address

166 DUTCH RD
CHARLESTON WV
25302-4451
US

V. Phone/Fax

Practice location:
  • Phone: 304-513-3900
  • Fax:
Mailing address:
  • Phone: 304-926-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: