Provider Demographics
NPI:1780411199
Name:ADAMS, MICHALENE (CDCA)
Entity type:Individual
Prefix:
First Name:MICHALENE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 LAGONDA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-4339
Mailing Address - Country:US
Mailing Address - Phone:937-818-5324
Mailing Address - Fax:
Practice Address - Street 1:2960 W ENON RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-8548
Practice Address - Country:US
Practice Address - Phone:937-272-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)