Provider Demographics
NPI:1568223733
Name:SEALS, ADRIENNE BAUGHTMAN (LMSW)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:BAUGHTMAN
Last Name:SEALS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:N
Other - Last Name:BAUGHTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:25 MARY SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-6048
Mailing Address - Country:US
Mailing Address - Phone:601-303-7908
Mailing Address - Fax:
Practice Address - Street 1:1510 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2716
Practice Address - Country:US
Practice Address - Phone:601-684-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14907104100000X
MSM9325104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker