Provider Demographics
NPI:1114788338
Name:ADEKANBI, OLUBUNMI
Entity Type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:
Last Name:ADEKANBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BUNMI
Other - Middle Name:
Other - Last Name:PROFESSIONAL SERVICES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3760 SANTA MARIA DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2443
Mailing Address - Country:US
Mailing Address - Phone:380-250-7949
Mailing Address - Fax:
Practice Address - Street 1:3760 SANTA MARIA DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2443
Practice Address - Country:US
Practice Address - Phone:380-250-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool