=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780941351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANDRA L ADAMS, PHD, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2012
-----------------------------------------------------
Last Update Date | 04/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2270 HIGHWAY 87
-----------------------------------------------------
City | NAVARRE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32566-3215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-939-0094
-----------------------------------------------------
Fax | 850-677-3173
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2270 HIGHWAY 87
-----------------------------------------------------
City | NAVARRE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32566-3215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-939-0094
-----------------------------------------------------
Fax | 850-677-3173
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | DR. SANDRA L ADAMS
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 850-939-0094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 8401
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------