Healthcare Provider Details

I. General information

NPI: 1275318057
Provider Name (Legal Business Name): ADEBOLA ADELAKUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 7TH ST STE 301
LAUREL MD
20707-3959
US

IV. Provider business mailing address

1200 LAUREL OAK RD STE 102
VOORHEES NJ
08043-4317
US

V. Phone/Fax

Practice location:
  • Phone: 856-314-8069
  • Fax:
Mailing address:
  • Phone: 856-314-8069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00470800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC13146
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: