Provider Demographics
NPI:1518097104
Name:ADAMS, STACY S SR (BS IN HUMAN SERVICES)
Entity Type:Individual
Prefix:MR
First Name:STACY
Middle Name:S
Last Name:ADAMS
Suffix:SR
Gender:M
Credentials:BS IN HUMAN SERVICES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3576 ARLINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3907
Mailing Address - Country:US
Mailing Address - Phone:951-374-1555
Mailing Address - Fax:951-394-7426
Practice Address - Street 1:3576 ARLINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3907
Practice Address - Country:US
Practice Address - Phone:951-374-1555
Practice Address - Fax:951-394-7426
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program