Provider Demographics
NPI:1669745568
Name:ADAMS, ROSALYN F (MED)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:F
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 SHILELAGH OAKS PKWY
Mailing Address - Street 2:
Mailing Address - City:RAVENEL
Mailing Address - State:SC
Mailing Address - Zip Code:29470-5236
Mailing Address - Country:US
Mailing Address - Phone:843-889-6403
Mailing Address - Fax:
Practice Address - Street 1:6220 SHILELAGH OAKS PKWY
Practice Address - Street 2:
Practice Address - City:RAVENEL
Practice Address - State:SC
Practice Address - Zip Code:29470-5236
Practice Address - Country:US
Practice Address - Phone:843-860-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional