Provider Demographics
NPI:1013921238
Name:ADIGWEME, MARIA ADAMMA (LMHC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ADAMMA
Last Name:ADIGWEME
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9521 SHELLIE RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6167
Mailing Address - Country:US
Mailing Address - Phone:904-619-3010
Mailing Address - Fax:904-619-3233
Practice Address - Street 1:9521 SHELLIE RD
Practice Address - Street 2:SUITE 15
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6167
Practice Address - Country:US
Practice Address - Phone:904-619-3010
Practice Address - Fax:904-619-3233
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1092OtherBC/BS
FL7288248OtherAETNA