Provider Demographics
NPI:1578106258
Name:DAYMON-ADAMS, MARSHA (PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:
Last Name:DAYMON-ADAMS
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 WOODY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5777
Mailing Address - Country:US
Mailing Address - Phone:704-496-1186
Mailing Address - Fax:
Practice Address - Street 1:10000 WOODY RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5777
Practice Address - Country:US
Practice Address - Phone:704-496-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL060-1060320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities