MEDICARE: KATRINA RENAE ADAMS LCSW

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	1041C0700X	Clinical Social Worker	8053-C	AR

General Provider Information

NPI Number	:	1821440181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA RENAE ADAMS LCSW

Provider Business Mailing Address
First Line	:	1318 STONE ST
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-4522
Country	:	US
Telephone Number	:	501-213-1330
Fax Number	:	501-421-2135

Provider Business Practice Location Address
First Line	:	1318 STONE ST
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-4522
Country	:	US
Telephone Number	:	501-213-1330
Fax Number	:	501-421-2135

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	03/13/2024

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