Provider Demographics
NPI:1558482141
Name:ADAMIEC, THERESE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:MARIE
Last Name:ADAMIEC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 FAIR MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76180-2611
Mailing Address - Country:US
Mailing Address - Phone:817-228-6819
Mailing Address - Fax:866-801-2988
Practice Address - Street 1:6812 FAIR MEADOWS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76180-2611
Practice Address - Country:US
Practice Address - Phone:817-228-6819
Practice Address - Fax:866-801-2988
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3197103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service