Healthcare Provider Details

I. General information

NPI: 1619743481
Provider Name (Legal Business Name): SULAIMAN ADEDAPO ADEJUMOBI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

12155 W CHARISMATIC DR
MARANA AZ
85653-1079
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax:
Mailing address:
  • Phone: 214-606-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149029156
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: