Provider Demographics
NPI:1053759845
Name:ADESINA, KEHINDE A (PHD)
Entity type:Individual
Prefix:DR
First Name:KEHINDE
Middle Name:A
Last Name:ADESINA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-8235
Mailing Address - Country:US
Mailing Address - Phone:707-501-8552
Mailing Address - Fax:
Practice Address - Street 1:874 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-8235
Practice Address - Country:US
Practice Address - Phone:707-501-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW35588101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor