Mary D'Adam, LCPC, CADC
Individual provider Active NPI Counselor · Manhattan, IL
NPI 1265830236 · NPPES record last updated Aug 25, 2026
Key facts
- NPI
- 1265830236
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 180.014447 (IL)
- Practice address
- 25047 S Blackthorne Rd
Manhattan, IL 60442-9189 - Phone
- (773) 627-6417
- NPI assigned
- Dec 8, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.014447 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roots of Regulation Counseling LLC | Mental Health | Current |
Accepting new patients |
Interoperability endpoints
- lifestancehealth.marydadam@146897.advancedmd-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 180.014447 | IL | Yes |
Addresses
Primary practice location
25047 S Blackthorne Rd
Manhattan, IL 60442-9189
Mailing address
25047 S Blackthorne Rd
Manhattan, IL 60442-9189
Other providers in Manhattan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.