MEDICARE: JUANITA E ADKINS M,S,, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-14-9806	MD

General Provider Information

NPI Number	:	1043601438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA E ADKINS M,S,, BCBA

Provider Business Mailing Address
First Line	:	5004 WILLOW BRANCH WAY UNIT 103
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5126
Country	:	US
Telephone Number	:	443-257-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	8950 OLD ANNAPOLIS RD
Second Line	:	SUITE 123
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2273
Country	:	US
Telephone Number	:	443-863-6949
Fax Number	:	866-857-0246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2015
Last Update Date	:	02/06/2015

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