Provider Demographics
NPI:1942019427
Name:ADAMS, WANDA ANGELICA DAWN (MFT)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:ANGELICA DAWN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:199 N 290 W STE 150
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-5004
Mailing Address - Country:US
Mailing Address - Phone:801-787-3784
Mailing Address - Fax:
Practice Address - Street 1:199 N 290 W STE 150
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-5004
Practice Address - Country:US
Practice Address - Phone:801-787-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7784827-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist