Provider Demographics
NPI:1295916534
Name:JUSTICE, ADENA CAROL
Entity type:Individual
Prefix:MS
First Name:ADENA
Middle Name:CAROL
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 BROADLEAF RD
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-6017
Mailing Address - Country:US
Mailing Address - Phone:606-205-7385
Mailing Address - Fax:606-433-9690
Practice Address - Street 1:1116 BROADLEAF RD
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-6017
Practice Address - Country:US
Practice Address - Phone:606-205-7385
Practice Address - Fax:606-433-9690
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker