Provider Demographics
NPI:1255077715
Name:HARRISON, ADAM S
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:S
Last Name:HARRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 DIXIE HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2369
Mailing Address - Country:US
Mailing Address - Phone:859-484-8884
Mailing Address - Fax:
Practice Address - Street 1:3005 DIXIE HWY STE 250
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2369
Practice Address - Country:US
Practice Address - Phone:859-484-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2565291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical