Provider Demographics
NPI:1730140690
Name:ADAMS, DIANE M (LCSW MAC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCSW MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35510 EDS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTON
Mailing Address - State:MT
Mailing Address - Zip Code:59820
Mailing Address - Country:US
Mailing Address - Phone:406-728-8388
Mailing Address - Fax:
Practice Address - Street 1:1600 SOUTH AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-728-8388
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT473104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
473OtherLICENSE
MO0503013Medicaid