Provider Demographics
NPI:1134275332
Name:AKINLADE, EBENEZER OLUGBENGA (LMSW)
Entity type:Individual
Prefix:MR
First Name:EBENEZER
Middle Name:OLUGBENGA
Last Name:AKINLADE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MISTY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-9055
Mailing Address - Country:US
Mailing Address - Phone:678-369-0930
Mailing Address - Fax:678-302-7000
Practice Address - Street 1:201 MISTY GROVE DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-9055
Practice Address - Country:US
Practice Address - Phone:678-369-0930
Practice Address - Fax:678-302-7000
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW004082104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker