Provider Demographics
NPI:1306681804
Name:ADAMS, ROSLYN (AGENT)
Entity type:Individual
Prefix:
First Name:ROSLYN
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:AGENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 MIDCOURT RD STE 119
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-5915
Mailing Address - Country:US
Mailing Address - Phone:803-386-8383
Mailing Address - Fax:803-497-2721
Practice Address - Street 1:125 GAULEY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-2887
Practice Address - Country:US
Practice Address - Phone:803-386-3883
Practice Address - Fax:803-497-2721
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20851945171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator