Basic Information
| Provider Information | |||||||||
| NPI: | 1093941585 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADEBANJO-ONAPEJU | ||||||||
| FirstName: | OLASUBOMI | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | PLMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 S 11TH ST | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027064642 | ||||||||
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| Practice Location | |||||||||
| Address1: | 923 E NORFOLK AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023790040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 06/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | P-703 | NE | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 8489 | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.