=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245620491
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAITLIN MINOR ADAMS LCMHC; LCAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2015
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 NORTHWEST LN
-----------------------------------------------------
City | WARRENSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28693-9244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-246-9449
-----------------------------------------------------
Fax | 336-384-1626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 208
-----------------------------------------------------
City | JEFFERSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28640-0208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-246-9449
-----------------------------------------------------
Fax | 336-982-3555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 11388
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 21391
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------