Provider Demographics
NPI:1952941973
Name:ADEOTI, AYOWOLE (MS LCDC)
Entity Type:Individual
Prefix:
First Name:AYOWOLE
Middle Name:
Last Name:ADEOTI
Suffix:
Gender:M
Credentials:MS LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7457 HARWIN DR STE 303H
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2027
Mailing Address - Country:US
Mailing Address - Phone:832-649-3083
Mailing Address - Fax:832-831-1655
Practice Address - Street 1:7457 HARWIN DR STE 303H
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2027
Practice Address - Country:US
Practice Address - Phone:832-649-8038
Practice Address - Fax:832-831-1655
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4265261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1336641638Medicaid