Provider Demographics
NPI:1508040767
Name:WANNIE, ADAM H (LMHC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:H
Last Name:WANNIE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 HOLLOW RUN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632
Mailing Address - Country:US
Mailing Address - Phone:508-340-0847
Mailing Address - Fax:508-437-0239
Practice Address - Street 1:572 MAIN STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-4909
Practice Address - Country:US
Practice Address - Phone:508-340-0847
Practice Address - Fax:508-790-8301
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health