Provider Demographics
NPI:1912055377
Name:ADAMS, CAROL LYNNE (MSW, LMSW, CCSR, CA)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNNE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MSW, LMSW, CCSR, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BATES STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3603
Mailing Address - Country:US
Mailing Address - Phone:517-914-2166
Mailing Address - Fax:517-784-3030
Practice Address - Street 1:215 BATES STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3603
Practice Address - Country:US
Practice Address - Phone:517-914-2166
Practice Address - Fax:517-914-3030
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803084991104100000X
MI68010901211041C0700X, 171M00000X
MICACR101YA0400X
MICCSR101YP2500X
MIS-20076101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator