Basic Information
| Provider Information | |||||||||
| NPI: | 1245704980 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STONESTREET | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | LGSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | COMMUNITY CARE OF BRIDGEPORT | ||||||||
| Address2: | 65 PROFESSIONAL PLACE | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048485770 | ||||||||
| FaxNumber: | 3048480890 | ||||||||
| Practice Location | |||||||||
| Address1: | COMMUNITY CARE OF BRIDGEPORT | ||||||||
| Address2: | 65 PROFESSIONAL PLACE | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048485770 | ||||||||
| FaxNumber: | 3048480890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2019 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | BP00945299 | WV | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.