Provider Demographics
NPI:1861938029
Name:ADAMS, LOU ANN
Entity type:Individual
Prefix:MISS
First Name:LOU
Middle Name:ANN
Last Name:ADAMS
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:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:AXTON
Mailing Address - State:VA
Mailing Address - Zip Code:24054-0374
Mailing Address - Country:US
Mailing Address - Phone:276-790-2263
Mailing Address - Fax:276-632-1074
Practice Address - Street 1:374 YEATTS RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-0434
Practice Address - Country:US
Practice Address - Phone:276-790-2263
Practice Address - Fax:276-632-1074
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0163719807171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0163719807Medicaid