Provider Demographics
NPI:1851869374
Name:ADAMS, MARLENE JOAN
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:JOAN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 STOCKTON ST APT 108
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4065
Mailing Address - Country:US
Mailing Address - Phone:570-947-5730
Mailing Address - Fax:
Practice Address - Street 1:7240 COURTLAND FARM RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:VA
Practice Address - Zip Code:23069-1564
Practice Address - Country:US
Practice Address - Phone:804-365-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007859101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor