Provider Demographics
NPI:1730907965
Name:NARUG, ADRIENNE LIANNA (LMCHA)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LIANNA
Last Name:NARUG
Suffix:
Gender:F
Credentials:LMCHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 411 BOX 2037
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112-0021
Mailing Address - Country:US
Mailing Address - Phone:417-894-3788
Mailing Address - Fax:
Practice Address - Street 1:PSC 411 BOX 2037
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112-0021
Practice Address - Country:US
Practice Address - Phone:417-894-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61459291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health