Provider Demographics
NPI:1104491646
Name:ADAMS, MARY BETH (LPC, NCC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 WINDING CREEK CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4843
Mailing Address - Country:US
Mailing Address - Phone:706-231-1383
Mailing Address - Fax:
Practice Address - Street 1:752 WINDING CREEK CT
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4843
Practice Address - Country:US
Practice Address - Phone:706-231-1383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional