=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497401749
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JIMMIETTA ADAMS LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2022
-----------------------------------------------------
Last Update Date | 02/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6616 RONALD RD APT T1
-----------------------------------------------------
City | CAPITOL HEIGHTS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20743-7430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-415-7609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6616 RONALD RD APT T1
-----------------------------------------------------
City | CAPITOL HEIGHTS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20743-7430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-415-7609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 28066
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------