Healthcare Provider Details

I. General information

NPI: 1982203766
Provider Name (Legal Business Name): KEMISOLA AYILOGE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

4908 LOCKARD DR
OWINGS MILLS MD
21117-6111
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22993
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: