Provider Demographics
NPI:1578118055
Name:SAMANTHA ADJEKUM
Entity Type:Organization
Organization Name:SAMANTHA ADJEKUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADJEKUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:158-556-9171
Mailing Address - Street 1:24123 W LOCKPORT ST APT 101
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2864
Mailing Address - Country:US
Mailing Address - Phone:815-556-9171
Mailing Address - Fax:
Practice Address - Street 1:24123 W LOCKPORT ST APT 101
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2864
Practice Address - Country:US
Practice Address - Phone:815-556-9171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty