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General NPI Number Information
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NPI Number | 1659758167
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Entity Type | Organization
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Legal Business Name | ADAGIO THERAPY CENTER, LLC
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 388 STATE ST SUITE 707
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City | SALEM
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State | OR
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Zip | 97301-3866
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Country | US
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Telephone | 818-253-9264
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Fax |
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Provider Business Mailing Address
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Address Line | 388 STATE ST SUITE 707
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City | SALEM
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State | OR
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Zip | 97301-3866
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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 | CLINICAL PSYCHOLOGIST
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Name | DR. MARTHA WANG
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Credential | PHD
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Telephone | 818-253-9264
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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 | L6113
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2518
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License Number State | OR
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