Provider Demographics
NPI:1720684582
Name:ADKINS, JOHNATHAN TODD (LCAS-A)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:TODD
Last Name:ADKINS
Suffix:
Gender:M
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 DABNEY DR STE B
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-3946
Mailing Address - Country:US
Mailing Address - Phone:252-572-2625
Mailing Address - Fax:
Practice Address - Street 1:510 DABNEY DR STE B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3946
Practice Address - Country:US
Practice Address - Phone:252-572-2625
Practice Address - Fax:252-572-2955
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27013101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC27013OtherNCASPPB