Healthcare Provider Details

I. General information

NPI: 1255069225
Provider Name (Legal Business Name): MIKAELA LYNN ADKINS MSW, LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W MAPLE AVE
FAYETTEVILLE WV
25840-1413
US

IV. Provider business mailing address

209 W MAPLE AVE
FAYETTEVILLE WV
25840-1413
US

V. Phone/Fax

Practice location:
  • Phone: 304-574-2100
  • Fax:
Mailing address:
  • Phone: 304-574-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBP00946041
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: