Provider Demographics
NPI:1376806257
Name:ADAMS, TIJUANA P (MS, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:TIJUANA
Middle Name:P
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 S MEMORIAL DR STE 5
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6238
Mailing Address - Country:US
Mailing Address - Phone:252-364-6007
Mailing Address - Fax:888-509-1504
Practice Address - Street 1:3011 S MEMORIAL DR STE 5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6238
Practice Address - Country:US
Practice Address - Phone:252-364-6007
Practice Address - Fax:888-509-1504
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1376806257Medicaid