Individual
JESSICA ADONTENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
468 MAIN STREET, STURBRIDGE, MA 01518
(774) 452-9533
Mailing address
93 LENO RD, HOLLAND, MA 01521-2707
(774) 452-9533
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
11097
MA
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306421
—
MA
05
—
1308785
—
MA
01
—
22220002001
BLUE CROSS BLUE SHEILD
MA
01
—
M18684
BLUE CROSS BLUE SHEILD
MA
Enumeration date
09/24/2012
Last updated
07/09/2021
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