Provider Demographics
NPI:1225812282
Name:ADEBIYI, ENOBONG OLUWATOBI
Entity Type:Individual
Prefix:
First Name:ENOBONG
Middle Name:OLUWATOBI
Last Name:ADEBIYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ENOBONG
Other - Middle Name:OLUWATOBI
Other - Last Name:UKAP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8301 GRAYSON TRL
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6869
Mailing Address - Country:US
Mailing Address - Phone:254-345-9824
Mailing Address - Fax:
Practice Address - Street 1:CARL R. DARNALL ARMY MEDICAL CENTER 36065 SANTA FE AVE,
Practice Address - Street 2:
Practice Address - City:FORT-HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109772104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker