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General NPI Number Information
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NPI Number | 1740759026
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Entity Type | Individual
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Provider Name | OLUDARA ADEEYO
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Gender | Female
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Dates
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Enumeration Date | 11/16/2018
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 1849 SAWTELLE BLVD STE 610
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City | LOS ANGELES
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State | CA
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Zip | 90025-7013
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Country | US
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Telephone | 747-222-6714
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Fax |
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Provider Business Mailing Address
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Address Line | 4858 W PICO BLVD # 330
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City | LOS ANGELES
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State | CA
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Zip | 90019-4225
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Country | US
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Telephone | 747-222-6714
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW89439
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW113051
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License Number State | CA
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