Provider Demographics
NPI:1780331116
Name:ADEBAYO, LUKMAN ADEKUNLE (LCSW)
Entity type:Individual
Prefix:MR
First Name:LUKMAN
Middle Name:ADEKUNLE
Last Name:ADEBAYO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4791 COUNTRY COVE WAY
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4791 COUNTRY COVE WAY
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-5378
Practice Address - Country:US
Practice Address - Phone:678-383-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0074951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical