Provider Demographics
NPI:1669925103
Name:ADESINA, EGOCHI (LCPC)
Entity type:Individual
Prefix:
First Name:EGOCHI
Middle Name:
Last Name:ADESINA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 SECURITY BLVD STE 21
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-8419
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:866-629-0091
Practice Address - Street 1:6901 SECURITY BLVD STE 21
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-8419
Practice Address - Country:US
Practice Address - Phone:410-837-2050
Practice Address - Fax:866-629-0091
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7235101Y00000X
MDLC8845101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor