Provider Demographics
NPI:1013175868
Name:ADAMS, MERRITT (CADCIII)
Entity Type:Individual
Prefix:
First Name:MERRITT
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:CADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 MAIN STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1032
Mailing Address - Country:US
Mailing Address - Phone:262-632-1780
Mailing Address - Fax:262-632-0895
Practice Address - Street 1:1717 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-2405
Practice Address - Country:US
Practice Address - Phone:262-632-1780
Practice Address - Fax:262-632-0895
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11643 1585101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39173000Medicaid