Healthcare Provider Details

I. General information

NPI: 1497409361
Provider Name (Legal Business Name): FOLASADE A OWOLABI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10451 TWIN RIVERS RD STE 100
COLUMBIA MD
21044-2332
US

IV. Provider business mailing address

4623 FALLS RD
BALTIMORE MD
21209-4914
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-3557
  • Fax:
Mailing address:
  • Phone: 410-366-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number22323
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: