Provider Demographics
NPI:1760542062
Name:ADEDOKUN, JOSEPH OLATUNDE (LCAS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:OLATUNDE
Last Name:ADEDOKUN
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:DR
Other - First Name:SUHBASH
Other - Middle Name:P
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1003 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9376
Mailing Address - Country:US
Mailing Address - Phone:704-922-0012
Mailing Address - Fax:704-852-4488
Practice Address - Street 1:432 E LONG AVE STE 1
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2540
Practice Address - Country:US
Practice Address - Phone:704-854-9595
Practice Address - Fax:704-852-4488
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111767Medicaid