Provider Demographics
NPI:1104248491
Name:ADAMS, RENEE WATSON (LPCA)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:WATSON
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 GODWIN LN
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576-8499
Mailing Address - Country:US
Mailing Address - Phone:919-631-4831
Mailing Address - Fax:
Practice Address - Street 1:48 GODWIN LN
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-8499
Practice Address - Country:US
Practice Address - Phone:919-631-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPCA10621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health