Provider Demographics
NPI:1245704980
Name:STONESTREET, ADAM CHRISTOPHER (LGSW)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:CHRISTOPHER
Last Name:STONESTREET
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMUNITY CARE OF BRIDGEPORT
Mailing Address - Street 2:65 PROFESSIONAL PLACE
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330
Mailing Address - Country:US
Mailing Address - Phone:304-848-5770
Mailing Address - Fax:304-848-0890
Practice Address - Street 1:COMMUNITY CARE OF BRIDGEPORT
Practice Address - Street 2:65 PROFESSIONAL PLACE
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:304-848-5770
Practice Address - Fax:304-848-0890
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00945299104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker