Provider Demographics
NPI:1245857838
Name:ADEGITE, LATIFAT
Entity type:Individual
Prefix:MRS
First Name:LATIFAT
Middle Name:
Last Name:ADEGITE
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 1:10805 THREE CHOPT RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2019
Mailing Address - Country:US
Mailing Address - Phone:804-299-0381
Mailing Address - Fax:
Practice Address - Street 1:10805 THREE CHOPT RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-2019
Practice Address - Country:US
Practice Address - Phone:804-299-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3747A0650X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider