Healthcare Provider Details

I. General information

NPI: 1184163222
Provider Name (Legal Business Name): DAMILOLA OLOFINLUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9510 SHERIDAN ST
LANHAM MD
20706-2636
US

IV. Provider business mailing address

9510 SHERIDAN STREET
LANHAM MD
20706
US

V. Phone/Fax

Practice location:
  • Phone: 202-258-5673
  • Fax:
Mailing address:
  • Phone: 202-258-5673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: