Provider Demographics
NPI:1962740803
Name:ADAMS, MARTHA H (LISW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:H
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 ANNA KNAPP EXT
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5400
Mailing Address - Country:US
Mailing Address - Phone:843-696-7920
Mailing Address - Fax:843-884-0061
Practice Address - Street 1:1012 ANNA KNAPP EXT
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5400
Practice Address - Country:US
Practice Address - Phone:843-696-7920
Practice Address - Fax:843-884-0061
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8970 LISW101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional