Provider Demographics
NPI:1093152936
Name:SCHULTZ, ADRIENNE NICOLE (MED)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:NICOLE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E CENTER ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2254
Mailing Address - Country:US
Mailing Address - Phone:484-554-6183
Mailing Address - Fax:
Practice Address - Street 1:25 E CENTER ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2254
Practice Address - Country:US
Practice Address - Phone:484-554-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-02
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health