Provider Demographics
NPI:1568052082
Name:HOWARD, ADRIAN LINESE
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:LINESE
Last Name:HOWARD
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 1:4501 SHERATON DR APT 731
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1339
Mailing Address - Country:US
Mailing Address - Phone:478-335-8825
Mailing Address - Fax:
Practice Address - Street 1:4501 SHERATON DR APT 731
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1339
Practice Address - Country:US
Practice Address - Phone:478-335-8825
Practice Address - Fax:478-845-7567
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist