Provider Demographics
NPI:1083944656
Name:WILLS, ADAM D E (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:D E
Last Name:WILLS
Suffix:
Gender:M
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 E RICH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2131
Mailing Address - Country:US
Mailing Address - Phone:419-579-0274
Mailing Address - Fax:
Practice Address - Street 1:1595 E RICH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2131
Practice Address - Country:US
Practice Address - Phone:419-579-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490163581041C0700X
OHI. 11012431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000750568OtherANTHEM
12302929OtherCAQH: HUMANA, QUALITY CARE PARTNERS, AETNA, MED MUTUAL, TRICARE, THE HEALTH PLAN
H058360Medicare PIN