Provider Demographics
NPI:1275318057
Name:ADELAKUN, ADEBOLA
Entity Type:Individual
Prefix:
First Name:ADEBOLA
Middle Name:
Last Name:ADELAKUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 LAUREL OAK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4317
Mailing Address - Country:US
Mailing Address - Phone:856-314-8069
Mailing Address - Fax:
Practice Address - Street 1:603 7TH ST STE 301
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3959
Practice Address - Country:US
Practice Address - Phone:856-314-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC13146101YP2500X
NJ37PC00470800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional