Provider Demographics
NPI:1821440181
Name:ADAMS, KATRINA RENAE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:RENAE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 STONE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4522
Mailing Address - Country:US
Mailing Address - Phone:501-213-1330
Mailing Address - Fax:501-421-2135
Practice Address - Street 1:1318 STONE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4522
Practice Address - Country:US
Practice Address - Phone:501-213-1330
Practice Address - Fax:501-421-2135
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8053-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical