Provider Demographics
NPI:1306029079
Name:ADAMS, MARY L (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31805 MIDDLEBELT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2367
Mailing Address - Country:US
Mailing Address - Phone:248-865-1164
Mailing Address - Fax:
Practice Address - Street 1:31805 MIDDLEBELT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2367
Practice Address - Country:US
Practice Address - Phone:248-865-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010194051041C0700X
MI102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical