Provider Demographics
NPI:1295229094
Name:ADAMS, CASEY (RBT-18-57708)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RBT-18-57708
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-4010
Mailing Address - Country:US
Mailing Address - Phone:248-298-6439
Mailing Address - Fax:
Practice Address - Street 1:1881 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-4010
Practice Address - Country:US
Practice Address - Phone:248-298-6439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18-57708106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician