Provider Demographics
NPI:1447716170
Name:ADEKOMI PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:ADEKOMI PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:YEKEEN
Authorized Official - Middle Name:KOLAJO
Authorized Official - Last Name:ODEWALE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:410-300-6461
Mailing Address - Street 1:4815 COYLE RD APT 204
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5080
Mailing Address - Country:US
Mailing Address - Phone:410-762-8945
Mailing Address - Fax:410-744-4579
Practice Address - Street 1:4515 HIDDEN STREAM CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4837
Practice Address - Country:US
Practice Address - Phone:410-300-6461
Practice Address - Fax:410-744-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD117396100Medicaid