Provider Demographics
NPI:1104385723
Name:ADAMS, KIM B (CPRS)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:B
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4067 BEULAH RD
Mailing Address - Street 2:
Mailing Address - City:NATHALIE
Mailing Address - State:VA
Mailing Address - Zip Code:24577-2653
Mailing Address - Country:US
Mailing Address - Phone:860-469-5462
Mailing Address - Fax:
Practice Address - Street 1:4067 BEULAH RD
Practice Address - Street 2:
Practice Address - City:NATHALIE
Practice Address - State:VA
Practice Address - Zip Code:24577-2653
Practice Address - Country:US
Practice Address - Phone:860-469-5462
Practice Address - Fax:434-333-7015
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)