Basic Information
| Provider Information | |||||||||
| NPI: | 1417174558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CAS-RAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4215 DUQUESNE AVE | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902322807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105498383 | ||||||||
| FaxNumber: | 3105496808 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 E HARRY BRIDGES BLVD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907445825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105498383 | ||||||||
| FaxNumber: | 3105496808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | A0503011414 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.