Provider Demographics
NPI:1932574035
Name:PERRY, ADRIENNE JAIMIE (MSW, LMSW, LCDC)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:JAIMIE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MSW, LMSW, LCDC
Other - Prefix:
Other - First Name:JAIMIE
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LMSW, LCDC
Mailing Address - Street 1:4749 ODOM RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7080
Mailing Address - Country:US
Mailing Address - Phone:409-200-2220
Mailing Address - Fax:
Practice Address - Street 1:156 S MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7882
Practice Address - Country:US
Practice Address - Phone:409-200-2220
Practice Address - Fax:409-440-3344
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX104100000X
TX14632101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker