Provider Demographics
NPI:1396869459
Name:ADEGBITE, PAUL T (RAC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:ADEGBITE
Suffix:
Gender:M
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 QUENTIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3647
Mailing Address - Country:US
Mailing Address - Phone:301-313-0305
Mailing Address - Fax:
Practice Address - Street 1:1125 SPRING RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1421
Practice Address - Country:US
Practice Address - Phone:202-576-5720
Practice Address - Fax:202-576-6122
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCADD13885101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health