Basic Information
| Provider Information | |||||||||
| NPI: | 1609151190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCADAM | ||||||||
| FirstName: | ALFRED | ||||||||
| MiddleName: | IGNATIOUS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MFT INTERN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCADAM | ||||||||
| OtherFirstName: | ALFRED | ||||||||
| OtherMiddleName: | IGNATIOUS | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MFTINTERN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3720 ADAMS ST APT 106C | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925043346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513545447 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11951 HESPERIA ROAD | ||||||||
| Address2: | COUNTY OF SAN BERNARDINO | ||||||||
| City: | HESPERIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609562345 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2011 | ||||||||
| LastUpdateDate: | 10/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 60313 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.