=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013506575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE ADAMS LCSW, LISW-CP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2021
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3524 JEFFERSON DAVIS HWY
-----------------------------------------------------
City | GRANITEVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-250-1442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1702 HASTINGS ST
-----------------------------------------------------
City | GROVETOWN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30813-3977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-710-3666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW007436
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------