Provider Demographics
NPI:1669230330
Name:ADELEKE, OMOBOLA SOLA
Entity type:Individual
Prefix:
First Name:OMOBOLA
Middle Name:SOLA
Last Name:ADELEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-5229
Mailing Address - Country:US
Mailing Address - Phone:626-639-9186
Mailing Address - Fax:740-247-8163
Practice Address - Street 1:20 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-5229
Practice Address - Country:US
Practice Address - Phone:626-639-9186
Practice Address - Fax:740-247-8163
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198320401101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health