Provider Demographics
NPI:1831103498
Name:ADAMS, LYNN JAQUAY (LCSW, PIP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:JAQUAY
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CYPRESS BEND DRIVE
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-2773
Mailing Address - Country:US
Mailing Address - Phone:251-967-7630
Mailing Address - Fax:251-967-7647
Practice Address - Street 1:350 CYPRESS BEND DR
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-2773
Practice Address - Country:US
Practice Address - Phone:251-967-7630
Practice Address - Fax:251-967-7647
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0651-1794C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS 32526Medicare UPIN
AL05152546ADAMedicare ID - Type Unspecified