Provider Demographics
NPI:1558649616
Name:ADEBOWALE, ABAYOMI OBABUNMI (MS, LPCMH, NCC)
Entity Type:Individual
Prefix:MR
First Name:ABAYOMI
Middle Name:OBABUNMI
Last Name:ADEBOWALE
Suffix:
Gender:M
Credentials:MS, LPCMH, NCC
Other - Prefix:
Other - First Name:ABAYOMI
Other - Middle Name:OBABUNMI
Other - Last Name:ADEBOWALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:501 SILVERSIDE RD
Mailing Address - Street 2:SUITE # 74
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1374
Mailing Address - Country:US
Mailing Address - Phone:302-377-6225
Mailing Address - Fax:
Practice Address - Street 1:501 SILVERSIDE RD
Practice Address - Street 2:SUITE # 74
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1374
Practice Address - Country:US
Practice Address - Phone:302-377-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-23
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health