Healthcare Provider Details

I. General information

NPI: 1669966024
Provider Name (Legal Business Name): ADEOLA ADEFOWOJU GBENRO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 ABBOTTS BRIDGE RD APT 403
DULUTH GA
30097-5753
US

IV. Provider business mailing address

6115 ABBOTTS BRIDGE RD APT 403
DULUTH GA
30097-5753
US

V. Phone/Fax

Practice location:
  • Phone: 678-338-0104
  • Fax:
Mailing address:
  • Phone: 678-338-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10350
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01196000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH25591
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC009220
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: