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General NPI Number Information
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NPI Number | 1194992503
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Entity Type | Individual
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Provider Name | ADRIAN MARIE BYRD LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 04/20/2024
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Provider Practice Location Address
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Address Line | 5130 HICKORY POINT FRONTAGE RD STE 219
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City | DECATUR
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State | IL
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Zip | 62526-9773
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Country | US
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Telephone | 217-358-4548
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Fax | 217-706-5779
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Provider Business Mailing Address
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Address Line | 5130 HICKORY POINT FRONTAGE RD STE 219
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City | DECATUR
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State | IL
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Zip | 62526-9773
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Country | US
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Telephone | 217-358-4548
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Fax | 217-706-5779
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149012906
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License Number State | IL
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