Provider Demographics
NPI:1194841460
Name:ADELANWA, GABRIEL W (LCPC)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:W
Last Name:ADELANWA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11942 TWINLAKES DR APT 24
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3183
Mailing Address - Country:US
Mailing Address - Phone:301-586-0010
Mailing Address - Fax:
Practice Address - Street 1:11942 TWINLAKES DR APT 24
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3183
Practice Address - Country:US
Practice Address - Phone:301-586-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1235101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health