Provider Demographics
NPI:1770315384
Name:ADAM, VIRGINIA (CHW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:ADAM
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:SALSBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24611 CARLYSLE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3138
Mailing Address - Country:US
Mailing Address - Phone:313-485-6963
Mailing Address - Fax:
Practice Address - Street 1:9021 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3726
Practice Address - Country:US
Practice Address - Phone:313-871-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker