Provider Demographics
NPI:1659568053
Name:ADESEKO, ELIZABETH J (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:ADESEKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W ADOUE ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511
Mailing Address - Country:US
Mailing Address - Phone:281-824-1480
Mailing Address - Fax:281-824-1479
Practice Address - Street 1:1111 W ADOUE ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511
Practice Address - Country:US
Practice Address - Phone:281-824-1480
Practice Address - Fax:281-824-1479
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX586481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098120AMedicaid