Provider Demographics
NPI:1144968033
Name:AJOSE-ADEOGUN, CANDACE M
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:M
Last Name:AJOSE-ADEOGUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SAMUEL JACOB DR # 31
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6072
Mailing Address - Country:US
Mailing Address - Phone:678-524-3764
Mailing Address - Fax:
Practice Address - Street 1:245 COUNTRY CLUB DR # 31
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9080
Practice Address - Country:US
Practice Address - Phone:470-712-5892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW002469104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker