Provider Demographics
NPI:1609151190
Name:MCADAM, ALFRED IGNATIOUS (MFT INTERN)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:IGNATIOUS
Last Name:MCADAM
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:ALFRED
Other - Middle Name:IGNATIOUS
Other - Last Name:MCADAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFTINTERN
Mailing Address - Street 1:3720 ADAMS ST APT 106C
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3346
Mailing Address - Country:US
Mailing Address - Phone:951-354-5447
Mailing Address - Fax:
Practice Address - Street 1:11951 HESPERIA ROAD
Practice Address - Street 2:COUNTY OF SAN BERNARDINO
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345
Practice Address - Country:US
Practice Address - Phone:760-956-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional