Provider Demographics
NPI:1144076548
Name:HADDIX, ADRIANNA JANE
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:JANE
Last Name:HADDIX
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 1:770 W HOLLAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48885-9743
Mailing Address - Country:US
Mailing Address - Phone:616-894-3232
Mailing Address - Fax:
Practice Address - Street 1:770 W HOLLAND LAKE RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MI
Practice Address - Zip Code:48885-9743
Practice Address - Country:US
Practice Address - Phone:616-894-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst