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General NPI Number Information
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NPI Number | 1578810859
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Entity Type | Individual
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Provider Name | ADAOBI C IHEDURU PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 4020 E PONCE DE LEON AVE
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City | CLARKSTON
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State | GA
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Zip | 30021-1815
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Country | US
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Telephone | 470-545-2776
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Fax |
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Provider Business Mailing Address
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Address Line | 4684 STONEHENGE DR
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30096-2989
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY004016
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License Number State | GA
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