Provider Demographics
NPI:1831633858
Name:ADAMS, METTIA ANN (LCAS)
Entity type:Individual
Prefix:MRS
First Name:METTIA
Middle Name:ANN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8345 SOUTH HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:BOOMER
Mailing Address - State:NC
Mailing Address - Zip Code:28606
Mailing Address - Country:US
Mailing Address - Phone:336-469-1963
Mailing Address - Fax:
Practice Address - Street 1:5820 E WT HARRIS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3541
Practice Address - Country:US
Practice Address - Phone:704-251-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22651101YA0400X
NCLCAS-22651171W00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831633858Medicaid