Provider Demographics
NPI:1528713377
Name:ROTHROCK, ADAM (CADAC II)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ROTHROCK
Suffix:
Gender:M
Credentials:CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 TURFWAY CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-8176
Mailing Address - Country:US
Mailing Address - Phone:317-260-3605
Mailing Address - Fax:
Practice Address - Street 1:4614 TURFWAY CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8176
Practice Address - Country:US
Practice Address - Phone:317-260-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1050237875OtherDLN