Provider Demographics
NPI:1568963445
Name:SOYEMI, ADEBOLA ADEGBOLA (LMFT)
Entity Type:Individual
Prefix:
First Name:ADEBOLA
Middle Name:ADEGBOLA
Last Name:SOYEMI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70904
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513-0904
Mailing Address - Country:US
Mailing Address - Phone:909-534-5739
Mailing Address - Fax:
Practice Address - Street 1:11683 CARLY CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5984
Practice Address - Country:US
Practice Address - Phone:909-534-5739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT142503106H00000X
CA102735106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist