MEDICARE: ELLEN 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	C007087	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q389480281	OTHER	NC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942505979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN ADAMS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 644
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28070-0644
Country	:	US
Telephone Number	:	980-875-8332
Fax Number	:	866-321-7379

Provider Business Practice Location Address
First Line	:	18125 W CATAWBA AVE
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-5641
Country	:	US
Telephone Number	:	980-875-8332
Fax Number	:	866-321-7379

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

Provider Enumeration Date	:	01/23/2011
Last Update Date	:	02/15/2017

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