Provider Demographics
NPI:1417435264
Name:ADAM, SAMIRA MOHAMED
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:MOHAMED
Last Name:ADAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SOUTHVIEW BLVD APT 258
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-5804
Mailing Address - Country:US
Mailing Address - Phone:651-434-7551
Mailing Address - Fax:
Practice Address - Street 1:3548 BRYANT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4119
Practice Address - Country:US
Practice Address - Phone:612-822-8227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health