Provider Demographics
NPI:1104357094
Name:ADAMS, BYRON
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 JAYWICK AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2147
Mailing Address - Country:US
Mailing Address - Phone:240-538-7004
Mailing Address - Fax:
Practice Address - Street 1:12050 BALTIMORE AVENUE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705
Practice Address - Country:US
Practice Address - Phone:240-538-7004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG1019801041S0200X
MD181821041S0200X
DCLMFT000088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCLMFT000088OtherLICENSE MARRIAGE AND FAMILY THERAPY
DCLG101980OtherDC SOCIAL WORK LICENSE
MD18182OtherSOCIAL WORK LICENSE
MD9173OtherMARYLAND EDUCATOR CERTIFICATE