Healthcare Provider Details

I. General information

NPI: 1578934386
Provider Name (Legal Business Name): MRS. VIRKANIA OKUNADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BOSTON STREET.
SALEM MA
01970-9998
US

IV. Provider business mailing address

77 E MERRIMACK ST
LOWELL MA
01852-1251
US

V. Phone/Fax

Practice location:
  • Phone: 978-844-9936
  • Fax:
Mailing address:
  • Phone: 978-764-4032
  • 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: