Provider Demographics
NPI:1255849451
Name:BAIN, ADRIENNE LEIGH (LISW, C-ASWCM)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:LEIGH
Last Name:BAIN
Suffix:
Gender:F
Credentials:LISW, C-ASWCM
Other - Prefix:MS
Other - First Name:ADRIENNE
Other - Middle Name:LEIGH
Other - Last Name:ZIMMERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW, C-ASWCM
Mailing Address - Street 1:4881 SUGAR MAPLE DR.
Mailing Address - Street 2:88 MDG/SGHH - EXCEPTIONAL FAMILY MEMBER PROGRAM
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5529
Mailing Address - Country:US
Mailing Address - Phone:937-257-5938
Mailing Address - Fax:937-656-3197
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-257-5938
Practice Address - Fax:937-656-1262
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22036971041C0700X
TX57176104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker