Provider Demographics
NPI:1174807317
Name:ADAMS, GINA MICHELLE (LPC)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:MICHELLE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MICHELLE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:5914 E HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-3972
Mailing Address - Country:US
Mailing Address - Phone:334-733-5503
Mailing Address - Fax:888-879-0315
Practice Address - Street 1:865 HONEYSUCKLE RD STE 1
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1221
Practice Address - Country:US
Practice Address - Phone:334-733-5503
Practice Address - Fax:888-879-0315
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1761A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional