Healthcare Provider Details

I. General information

NPI: 1487248621
Provider Name (Legal Business Name): ADEBOLA ADEPOJU BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6045 BOWDEN ST
AUSTELL GA
30106-3846
US

IV. Provider business mailing address

6045 BOWDEN ST
AUSTELL GA
30106-3846
US

V. Phone/Fax

Practice location:
  • Phone: 404-721-3572
  • Fax:
Mailing address:
  • Phone: 404-721-3572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-80277
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-145977
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: