Basic Information
| Provider Information | |||||||||
| NPI: | 1215244116 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | MONIQUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 419 E 7TH ST STE 207 | ||||||||
| Address2: | |||||||||
| City: | THE DALLES | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970582676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413862620 | ||||||||
| FaxNumber: | 5413866075 | ||||||||
| Practice Location | |||||||||
| Address1: | 551 LONE PINE BLVD | ||||||||
| Address2: | |||||||||
| City: | THE DALLES | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970589403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415066920 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2010 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | A4917 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.