Healthcare Provider Details

I. General information

NPI: 1497111835
Provider Name (Legal Business Name): ABIODUN BADAMOSI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2988 GEORGE WASHINGTON MEMORIAL HWY
HAYES VA
23072-3429
US

IV. Provider business mailing address

2988 GEORGE WASHINGTON MEMORIAL HWY
HAYES VA
23072-3429
US

V. Phone/Fax

Practice location:
  • Phone: 757-752-3839
  • Fax:
Mailing address:
  • Phone: 757-752-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0718000779
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: