Provider Demographics
NPI:1982118923
Name:SHITTU, AYODELE TRACY (CATC I)
Entity Type:Individual
Prefix:
First Name:AYODELE
Middle Name:TRACY
Last Name:SHITTU
Suffix:
Gender:F
Credentials:CATC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16314 CORNUTA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-4814
Mailing Address - Country:US
Mailing Address - Phone:562-461-9272
Mailing Address - Fax:
Practice Address - Street 1:16314 CORNUTA AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4814
Practice Address - Country:US
Practice Address - Phone:562-461-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)