Provider Demographics
NPI:1093266090
Name:ADEBOYEJO, RALIAT Q (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:RALIAT
Middle Name:Q
Last Name:ADEBOYEJO
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N MICHIGAN AVE STE 561
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7799
Mailing Address - Country:US
Mailing Address - Phone:872-267-0339
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7940
Practice Address - Country:US
Practice Address - Phone:312-722-6487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012231101YM0800X
180.011680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health