Provider Demographics
NPI:1164929931
Name:BONE, ADETOLA ABIOLA (BS)
Entity type:Individual
Prefix:
First Name:ADETOLA
Middle Name:ABIOLA
Last Name:BONE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 ELDRIDGE PKWY APT 524
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2170
Mailing Address - Country:US
Mailing Address - Phone:832-807-1330
Mailing Address - Fax:
Practice Address - Street 1:134 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5401
Practice Address - Country:US
Practice Address - Phone:252-270-1001
Practice Address - Fax:252-270-1002
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2025-08-19
Deactivation Date:2021-12-02
Deactivation Code:
Reactivation Date:2025-07-25
Provider Licenses
StateLicense IDTaxonomies
NC3197103K00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator