Provider Demographics
NPI:1831633858
Name:ADAMS, METTIA ANN (LCAS)
Entity type:Individual
Prefix:MRS
First Name:METTIA
Middle Name:ANN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 MULBERRY MILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-7709
Mailing Address - Country:US
Mailing Address - Phone:336-262-9914
Mailing Address - Fax:336-677-1506
Practice Address - Street 1:1334 MULBERRY MILL RD
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-7709
Practice Address - Country:US
Practice Address - Phone:336-262-9914
Practice Address - Fax:336-677-1506
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22651101YA0400X
NCLCAS-22651171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831633858Medicaid