Basic Information
| Provider Information | |||||||||
| NPI: | 1417586017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | JAMAL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 E OLIN AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537131467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082521320 | ||||||||
| FaxNumber: | 6082521333 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 E OLIN AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537131467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082521320 | ||||||||
| FaxNumber: | 6082521333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2020 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4594-226 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 8541-125 | 01 | WI | WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES | OTHER | 4594-226 | 01 | WI | WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES | OTHER |