Provider Demographics
NPI:1114207792
Name:ADAMS, ROB (CDP, GAC)
Entity Type:Individual
Prefix:
First Name:ROB
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:CDP, GAC
Other - Prefix:
Other - First Name:ROB
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDP, GAC
Mailing Address - Street 1:1610 BISHOP RD SW
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7303
Mailing Address - Country:US
Mailing Address - Phone:360-352-1052
Mailing Address - Fax:360-754-3401
Practice Address - Street 1:1610 BISHOP RD SW
Practice Address - Street 2:SUITE 105
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7303
Practice Address - Country:US
Practice Address - Phone:360-352-1052
Practice Address - Fax:360-754-3401
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 0001418101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)