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
StateLicense IDTaxonomies
IN101YA0400X, 101YM0800X, 103TA0700X, 103TB0200X, 106E00000X, 106H00000X, 106S00000X, 171M00000X, 172V00000X, 225C00000X, 251E00000X, 320600000X, 385HR2060X, 261QM0855X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No251E00000XAgenciesHome Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN85-0938219OtherAT HOME WITH ANGEL EYE'S LLC