Provider Demographics
NPI:1952183931
Name:ADEBAYO, GRACE EWOME
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:EWOME
Last Name:ADEBAYO
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 1:556 MANANAI PL APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-5377
Mailing Address - Country:US
Mailing Address - Phone:806-392-0293
Mailing Address - Fax:
Practice Address - Street 1:556 MANANAI PL APT A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-5377
Practice Address - Country:US
Practice Address - Phone:806-392-0293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician