Provider Demographics
NPI:1215336557
Name:ADIGWE, PATRICK (PHD)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:ADIGWE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 FORBES BLVD
Mailing Address - Street 2:100
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4807
Mailing Address - Country:US
Mailing Address - Phone:301-306-4590
Mailing Address - Fax:301-306-4591
Practice Address - Street 1:4601 FORBES BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4807
Practice Address - Country:US
Practice Address - Phone:301-306-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5657101YP2500X
DCPRC14436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional