Healthcare Provider Details

I. General information

NPI: 1669194163
Provider Name (Legal Business Name): OLUREMI AGBAJE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLUREMI OLUREMI MSW

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 CHAUTAUQUA AVE
LANHAM MD
20706-2039
US

IV. Provider business mailing address

10230 CHAUTAUQUA AVE
LANHAM MD
20706-2039
US

V. Phone/Fax

Practice location:
  • Phone: 240-467-1406
  • Fax:
Mailing address:
  • Phone: 240-467-1406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: