Provider Demographics
NPI:1194191981
Name:ADAMS, KENNETH (MFT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 MILITARY W STE 201E
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2450
Mailing Address - Country:US
Mailing Address - Phone:510-499-8568
Mailing Address - Fax:
Practice Address - Street 1:1440 MILITARY W STE 201E
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2450
Practice Address - Country:US
Practice Address - Phone:510-499-8568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 23807106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist