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General NPI Number Information
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NPI Number | 1982976387
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Entity Type | Organization
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Legal Business Name | ADAMS CENTER FOR PSYCHOLOGICAL WELLNESS, LLC
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Dates
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Enumeration Date | 01/31/2012
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 1498 SE TECH CENTER PL SUITE 385
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City | VANCOUVER
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State | WA
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Zip | 98683-9591
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Country | US
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Telephone | 360-980-1338
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Fax |
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Provider Business Mailing Address
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Address Line | 3514 SE 181ST AVE
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City | VANCOUVER
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State | WA
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Zip | 98683-8272
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Country | US
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Telephone | 360-980-1338
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MICHELLE D. ADAMS
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Credential |
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Telephone | 360-980-1338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY00002966
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License Number State | WA
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