Provider Demographics
NPI:1912239930
Name:ADAMS-QUALLS, LISA ANNETTE (SAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNETTE
Last Name:ADAMS-QUALLS
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GOLF CTR STE 189
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-4910
Mailing Address - Country:US
Mailing Address - Phone:574-747-5394
Mailing Address - Fax:
Practice Address - Street 1:3 GOLF CTR STE 189
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-4910
Practice Address - Country:US
Practice Address - Phone:574-747-5394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WI16040-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker