Provider Demographics
NPI:1912740200
Name:ADEPEGBA, ABISOLA
Entity type:Individual
Prefix:MRS
First Name:ABISOLA
Middle Name:
Last Name:ADEPEGBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GBEMISOLA
Other - Middle Name:
Other - Last Name:OKANLAWON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6635 NIU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-7093
Mailing Address - Country:US
Mailing Address - Phone:301-675-1343
Mailing Address - Fax:
Practice Address - Street 1:6635 NIU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-7093
Practice Address - Country:US
Practice Address - Phone:301-675-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-805-0101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health