Healthcare Provider Details

I. General information

NPI: 1619679446
Provider Name (Legal Business Name): MR. FESTUS OLONIYO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 TAYLOR ST NW
WASHINGTON DC
20011-5617
US

IV. Provider business mailing address

1221 TAYLOR ST NW
WASHINGTON DC
20011-5617
US

V. Phone/Fax

Practice location:
  • Phone: 202-464-9200
  • Fax: 202-829-1920
Mailing address:
  • Phone: 202-464-9200
  • Fax: 202-829-1920

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: