Provider Demographics
NPI:1639766553
Name:ADEGBOYE, JOHN A (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:ADEGBOYE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 GARDENSIDE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-0012
Mailing Address - Country:US
Mailing Address - Phone:404-593-9348
Mailing Address - Fax:
Practice Address - Street 1:3300 OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2423
Practice Address - Country:US
Practice Address - Phone:404-593-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health