MEDICARE: TEMITAYO IJADUOLA MS, LCMHCA, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A23111	NC

General Provider Information

NPI Number	:	1164357570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEMITAYO IJADUOLA MS, LCMHCA, NCC

Provider Business Mailing Address
First Line	:	1921 NEW GARDEN RD APT D102
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2195
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 NEW GARDEN RD APT D102
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2195
Country	:	US
Telephone Number	:	401-282-0030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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