Basic Information
| Provider Information | |||||||||
| NPI: | 1922647213 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | DERALD | ||||||||
| MiddleName: | NICK | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ED.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 458 OLD CHEROKEE RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290726971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032501742 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1135 GREGG HWY NW | ||||||||
| Address2: | |||||||||
| City: | AIKEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298016341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036417700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2020 | ||||||||
| LastUpdateDate: | 06/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 7249 | SC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.