Provider Demographics
NPI:1346905718
Name:ELLIOTT, ADAM (MA, ADC, ALC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MA, ADC, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-5204
Mailing Address - Country:US
Mailing Address - Phone:205-874-5438
Mailing Address - Fax:
Practice Address - Street 1:9 OFFICE PARK CIR STE 106
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2501
Practice Address - Country:US
Practice Address - Phone:205-730-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3937A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health