Provider Demographics
NPI:1720523046
Name:MAXWELL, ADRIANE (LMP)
Entity type:Individual
Prefix:MRS
First Name:ADRIANE
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SUN VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-8348
Mailing Address - Country:US
Mailing Address - Phone:843-732-4325
Mailing Address - Fax:
Practice Address - Street 1:2155 N PARK LN STE 108
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9261
Practice Address - Country:US
Practice Address - Phone:843-732-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9656225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist