Provider Demographics
NPI:1497241228
Name:ADAMS, TINA JANE (LCSW, MSW, BHP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:JANE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCSW, MSW, BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 BUCKBOARD TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-5287
Mailing Address - Country:US
Mailing Address - Phone:928-606-5306
Mailing Address - Fax:928-527-3119
Practice Address - Street 1:2717 N 4TH ST STE 23A
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1847
Practice Address - Country:US
Practice Address - Phone:928-606-5306
Practice Address - Fax:928-527-3119
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-04
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ171301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical