Provider Demographics
NPI:1003146564
Name:ADAMS, AMANDA JO (LISW-S)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 DEEDS RD SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7447
Mailing Address - Country:US
Mailing Address - Phone:740-404-1339
Mailing Address - Fax:
Practice Address - Street 1:905 RIVER RD STE A
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9560
Practice Address - Country:US
Practice Address - Phone:740-587-2822
Practice Address - Fax:740-587-2822
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 0600081 SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker