Provider Demographics
NPI:1568158970
Name:ADELUSI, KEHINDE BOSEDE
Entity Type:Individual
Prefix:
First Name:KEHINDE
Middle Name:BOSEDE
Last Name:ADELUSI
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 1:1550 WEBB ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-2934
Mailing Address - Country:US
Mailing Address - Phone:229-296-8366
Mailing Address - Fax:
Practice Address - Street 1:1550 WEBB ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-2934
Practice Address - Country:US
Practice Address - Phone:229-296-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health