Provider Demographics
NPI:1174969992
Name:IZEVBIGIE, ADESUWA (LCPC)
Entity type:Individual
Prefix:MS
First Name:ADESUWA
Middle Name:
Last Name:IZEVBIGIE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 FAIRLAKES PL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3100
Mailing Address - Country:US
Mailing Address - Phone:301-318-0141
Mailing Address - Fax:
Practice Address - Street 1:4355 NICOLE DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4349
Practice Address - Country:US
Practice Address - Phone:301-429-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
MDLC5466101YP2500X
DCPRC200001447101YP2500X
VA0701011508101YP2500X
MD101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional