Provider Demographics
NPI:1851642714
Name:ADAMS, LORNA KAY
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:KAY
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SE WALTON LAKES DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5104
Mailing Address - Country:US
Mailing Address - Phone:954-588-7145
Mailing Address - Fax:
Practice Address - Street 1:512 PORT ST. LUCIE BLVD.
Practice Address - Street 2:LEGACY BEHAVIORAL HEALTH CENTER, INC.
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953
Practice Address - Country:US
Practice Address - Phone:772-873-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 7392104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker