Provider Demographics
NPI:1518396332
Name:ADEWOLE, ANTHONIA
Entity Type:Individual
Prefix:
First Name:ANTHONIA
Middle Name:
Last Name:ADEWOLE
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 1:14935 S RICHMOND AVE APT 1718
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1595
Mailing Address - Country:US
Mailing Address - Phone:832-279-1847
Mailing Address - Fax:
Practice Address - Street 1:14935 S RICHMOND AVE APT 1718
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1595
Practice Address - Country:US
Practice Address - Phone:832-279-1847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX845900171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator