Provider Demographics
NPI: | 1952025025 |
---|---|
Name: | ADAMS, ANDREA JO LYNNE |
Entity Type: | Individual |
Prefix: | MS |
First Name: | ANDREA |
Middle Name: | JO LYNNE |
Last Name: | ADAMS |
Suffix: | |
Gender: | F |
Credentials: | |
Other - Prefix: | |
Other - First Name: | AT HOME WITH ANGEL |
Other - Middle Name: | EYES |
Other - Last Name: | LLC |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | |
Mailing Address - Street 1: | 5825 SUNSET WAY APT 2207 |
Mailing Address - Street 2: | |
Mailing Address - City: | WHITESTOWN |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46075-7573 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-945-5149 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5825 SUNSET WAY APT 2207 |
Practice Address - Street 2: | |
Practice Address - City: | WHITESTOWN |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46075-7573 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-945-5149 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2022-10-03 |
Last Update Date: | 2023-11-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 101YA0400X, 101YM0800X, 103TA0700X, 103TB0200X, 106E00000X, 106H00000X, 106S00000X, 171M00000X, 172V00000X, 225C00000X, 251E00000X, 320600000X, 385HR2060X, 261QM0855X | |
385H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No | 106E00000X | Behavioral Health & Social Service Providers | Assistant Behavior Analyst | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | |
No | 172V00000X | Other Service Providers | Community Health Worker | |
No | 225C00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | |
No | 251E00000X | Agencies | Home Health | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 385H00000X | Respite Care Facility | Respite Care | |
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 85-0938219 | Other | AT HOME WITH ANGEL EYE'S LLC |