=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245421841
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLEVERICK M ADAMS LMHC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2007
-----------------------------------------------------
Last Update Date | 08/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7432 HIGHWAY 50 SUITE 109
-----------------------------------------------------
City | GROVELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34736-9322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-470-2195
-----------------------------------------------------
Fax | 407-445-9145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7432 HIGHWAY 50 SUITE 109
-----------------------------------------------------
City | GROVELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34736-9322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-470-2195
-----------------------------------------------------
Fax | 407-445-9145
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | MAC-23612
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH8349
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TP2701X
-----------------------------------------------------
Taxonomy Name | Group Psychotherapy Psychologist
-----------------------------------------------------
License Number | MH8349
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------