Healthcare Provider Details

I. General information

NPI: 1629516596
Provider Name (Legal Business Name): OLUDAMILOLA SHODEINDE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 PHILADELPHIA CT
LANHAM MD
20706-4400
US

IV. Provider business mailing address

5514 AXTON CT
LANHAM MD
20706-2050
US

V. Phone/Fax

Practice location:
  • Phone: 301-477-3339
  • Fax:
Mailing address:
  • Phone: 301-273-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50080631
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16405
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: