MEDICARE: MR. SAMUEL ADIGHIJE

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

General Provider Information

NPI Number	:	1700388568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL ADIGHIJE

Provider Business Mailing Address
First Line	:	PO BOX 5168
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19141-5168
Country	:	US
Telephone Number	:	215-823-9635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1956 STERLING ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19138-2228
Country	:	US
Telephone Number	:	215-823-9635
Fax Number	:

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

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/07/2018

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