Provider Demographics
NPI:1649833344
Name:ADEGUNWA, BUSOLA SARAH (LPC)
Entity type:Individual
Prefix:
First Name:BUSOLA
Middle Name:SARAH
Last Name:ADEGUNWA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 HAMILTON MILL RD.
Mailing Address - Street 2:STE 102 #430
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519
Mailing Address - Country:US
Mailing Address - Phone:770-769-5671
Mailing Address - Fax:
Practice Address - Street 1:3300 HAMILTON MILL RD.
Practice Address - Street 2:STE 102 #430
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519
Practice Address - Country:US
Practice Address - Phone:770-769-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health