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General NPI Number Information
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NPI Number | 1245955335
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Entity Type | Individual
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Provider Name | DONNETTA R ADAMS
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Gender | Female
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 1303 WASHINGTON ST W
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City | CHARLESTON
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State | WV
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Zip | 25302-1333
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Country | US
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Telephone | 304-202-1699
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Fax |
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Provider Business Mailing Address
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Address Line | 2208 GRANT AVE
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City | SAINT ALBANS
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State | WV
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Zip | 25177-2057
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Country | US
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Telephone | 304-419-8968
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Fax |
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | WV
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