Healthcare Provider Details

I. General information

NPI: 1164357570
Provider Name (Legal Business Name): TEMITAYO CHRISTINE IJADUOLA MS, LCMHCA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 PARK RD
CHARLOTTE NC
28203-5922
US

IV. Provider business mailing address

1921 NEW GARDEN RD APT D102
GREENSBORO NC
27410-2195
US

V. Phone/Fax

Practice location:
  • Phone: 980-999-0483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23111
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: