Provider Demographics
NPI:1689384042
Name:ADAMS, REGINALD VERNELL (CAC-11)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:VERNELL
Last Name:ADAMS
Suffix:
Gender:M
Credentials:CAC-11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7902 OLD BRANCH AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1627
Mailing Address - Country:US
Mailing Address - Phone:301-856-2386
Mailing Address - Fax:
Practice Address - Street 1:7902 OLD BRANCH AVE STE 109
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1627
Practice Address - Country:US
Practice Address - Phone:301-856-2386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health