Provider Demographics
NPI:1255843652
Name:ADIGUN, OLULEYE (MA, MCAP, PHD CANDID)
Entity Type:Individual
Prefix:MR
First Name:OLULEYE
Middle Name:
Last Name:ADIGUN
Suffix:
Gender:M
Credentials:MA, MCAP, PHD CANDID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11924 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3856
Mailing Address - Country:US
Mailing Address - Phone:954-709-8341
Mailing Address - Fax:
Practice Address - Street 1:100 NW 170TH ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5510
Practice Address - Country:US
Practice Address - Phone:786-785-0585
Practice Address - Fax:786-780-2145
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCMHP100005101YM0800X
FLADC-002941-2014101YA0400X, 101YP2500X
FLMCAP100646261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA325658804590Medicaid