Provider Demographics
NPI:1932259116
Name:ADAMS, ROBERTA JEAN
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:JEAN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W CHICAGO ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036
Mailing Address - Country:US
Mailing Address - Phone:517-278-3660
Mailing Address - Fax:
Practice Address - Street 1:28 W CHICAGO ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036
Practice Address - Country:US
Practice Address - Phone:517-278-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002881101YM0800X
MI68010194241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
046869OtherVALUE OPTIONS
N81960002Medicare ID - Type Unspecified