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General NPI Number Information
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NPI Number | 1255849451
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Entity Type | Individual
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Provider Name | ADRIENNE LEIGH BAIN LISW, LCSW, C-ASWCM
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Gender | Female
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 4881 SUGAR MAPLE DR
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City | DAYTON
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State | OH
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Zip | 45433-5529
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Country | US
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Telephone | 937-257-5938
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Fax | 937-656-1262
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Provider Business Mailing Address
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Address Line | 4881 SUGAR MAPLE DR. 88 MDG/SGHH - EXCEPTIONAL FAMILY MEMBER PROGRAM
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City | DAYTON
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State | OH
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Zip | 45433-5529
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Country | US
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Telephone | 937-257-5938
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Fax | 937-656-3197
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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 | I.2203697
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 57176
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License Number State | TX
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