Healthcare Provider Details

I. General information

NPI: 1700798121
Provider Name (Legal Business Name): TAWAKALITU ATOLAGBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 DORAL CT
BOWIE MD
20721-2380
US

IV. Provider business mailing address

1712 DORAL CT
BOWIE MD
20721-2380
US

V. Phone/Fax

Practice location:
  • Phone: 301-836-8484
  • Fax:
Mailing address:
  • Phone: 301-836-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberHHA200006433
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: