Provider Demographics
NPI:1265843965
Name:ADAMS, COLLEEN (LMSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:DOHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37899 W 12 MILE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3048
Mailing Address - Country:US
Mailing Address - Phone:248-476-2229
Mailing Address - Fax:
Practice Address - Street 1:37899 W 12 MILE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3048
Practice Address - Country:US
Practice Address - Phone:248-476-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010920291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical