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General NPI Number Information
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NPI Number | 1265830236
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Entity Type | Individual
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Provider Name | MARY D'ADAM LCPC, CADC
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Gender | Female
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 20646 ABBEY WOODS CT N STE 302
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City | FRANKFORT
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State | IL
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Zip | 60423-3179
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Country | US
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Telephone | 312-476-9813
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Fax |
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Provider Business Mailing Address
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Address Line | 25047 S BLACKTHORNE RD
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City | MANHATTAN
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State | IL
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Zip | 60442-9189
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.014447
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License Number State | IL
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