Healthcare Provider Details

I. General information

NPI: 1285397422
Provider Name (Legal Business Name): OLUBUSOLA MABAYOJE AJIBOLA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

251 MACARTHUR BLVD APT 14
OAKLAND CA
94610-3138
US

V. Phone/Fax

Practice location:
  • Phone: 925-348-3090
  • Fax:
Mailing address:
  • Phone: 510-283-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: