=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447716170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADEKOMI PSYCHIATRIC SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2019
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4515 HIDDEN STREAM CT
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-4837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-300-6461
-----------------------------------------------------
Fax | 410-744-8945
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4815 COYLE RD APT 204
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-5080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-762-8945
-----------------------------------------------------
Fax | 410-744-4579
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. YEKEEN KOLAJO ODEWALE
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 410-300-6461
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------