Healthcare Provider Details

I. General information

NPI: 1467372912
Provider Name (Legal Business Name): OMOTAYO KOLA-OJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 MACARTHUR BLVD NW
WASHINGTON DC
20007-2521
US

IV. Provider business mailing address

438 BRADFORD DR
RED LION PA
17356-8473
US

V. Phone/Fax

Practice location:
  • Phone: 202-813-0454
  • Fax:
Mailing address:
  • Phone: 202-813-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: