Provider Demographics
NPI:1912597956
Name:ADAMS, KELLI (LCSW LISW)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 LOWELL DR
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-9573
Mailing Address - Country:US
Mailing Address - Phone:239-281-4365
Mailing Address - Fax:
Practice Address - Street 1:4906 LOWELL DR
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9573
Practice Address - Country:US
Practice Address - Phone:239-281-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.11013801041C0700X
FLSW117991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical