Provider Demographics
NPI:1215656889
Name:ADIELE, HENRY NDUBUISI
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:NDUBUISI
Last Name:ADIELE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11054 WORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-5829
Mailing Address - Country:US
Mailing Address - Phone:314-441-9059
Mailing Address - Fax:314-395-1000
Practice Address - Street 1:ST. LOUIS GREAT CIRCLE CAMPUS
Practice Address - Street 2:330 N. GORE AVENUE
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119
Practice Address - Country:US
Practice Address - Phone:314-301-4650
Practice Address - Fax:314-301-4652
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022032912101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor