Healthcare Provider Details

I. General information

NPI: 1275298853
Provider Name (Legal Business Name): FAITH OLUWADARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41307 12TH ST W
PALMDALE CA
93551-1445
US

IV. Provider business mailing address

41307 12TH ST W STE 105
PALMDALE CA
93551-1454
US

V. Phone/Fax

Practice location:
  • Phone: 661-544-5173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18279
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: