Provider Demographics
NPI:1770837882
Name:ADAMSKI, GINA LEE (LADC, CSAC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LEE
Last Name:ADAMSKI
Suffix:
Gender:F
Credentials:LADC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 TOWER AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2553
Mailing Address - Country:US
Mailing Address - Phone:218-336-9300
Mailing Address - Fax:715-392-8041
Practice Address - Street 1:1507 TOWER AVE STE 307
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2553
Practice Address - Country:US
Practice Address - Phone:218-336-9300
Practice Address - Fax:715-392-8041
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302972101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN302972OtherLADC