Provider Demographics
NPI:1164098372
Name:ADAMS, CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 NORTH DUKE STREET
Mailing Address - Street 2:SUITE 1, #1094
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1427
Mailing Address - Country:US
Mailing Address - Phone:919-627-7504
Mailing Address - Fax:
Practice Address - Street 1:3600 N DUKE ST UNIT 1094
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1709
Practice Address - Country:US
Practice Address - Phone:919-627-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0162151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP016215OtherLCSWA LICENSE NUMBER FROM NC SOCIAL WORK LICENSING BOARD
NC1528563194OtherGROUP NPI FROM THREE OAKS BEHAVIORAL HEALTH AND WELLNESS