Provider Demographics
NPI:1013750157
Name:JAMAL ADAMS LICENSED PROFESSIONAL CLINICAL COUNSELOR INC
Entity type:Organization
Organization Name:JAMAL ADAMS LICENSED PROFESSIONAL CLINICAL COUNSELOR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:DEVIN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, LPCC
Authorized Official - Phone:414-350-6433
Mailing Address - Street 1:2108 N ST STE N
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2108 N ST STE N
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5712
Practice Address - Country:US
Practice Address - Phone:509-768-2249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12278OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES
WI8541-125OtherWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES