Provider Demographics
NPI:1952806119
Name:ADAMS, LANETTA LYNN (LCPC)
Entity Type:Individual
Prefix:
First Name:LANETTA
Middle Name:LYNN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278-1337
Mailing Address - Country:US
Mailing Address - Phone:618-282-9642
Mailing Address - Fax:
Practice Address - Street 1:325 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278-1109
Practice Address - Country:US
Practice Address - Phone:618-980-9060
Practice Address - Fax:618-270-4775
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178002498101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional