Doctor Name: | MR. ADAM H WANNIE |
NPI Number: | 1508040767 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMHC |
License Number: | 5032 |
Business Practice Address: | 572 Main Street Suite 3 West Yarmouth, MA - 026734909 |
Business Phone Number: | 5083400847 |
Business Fax Number: | 5087908301 |
Mailing Address: | 142 Hollow Run Drive, CENTERVILLE |
State: | MA |
Postal Code: | 02632 |
Phone Number: | 5083400847 |
Fax Number: | 5084370239 |
NPI Enumeration Date: | 12/24/2007 |
NPI Last Update Date: | 12/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 5032 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |