Healthcare Provider Details

I. General information

NPI: 1023459187
Provider Name (Legal Business Name): OLUFUNKE OYERONKE ADETUNJI LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 ARMSTRONG CT APT A
LAUREL MD
20707-5124
US

IV. Provider business mailing address

11336 RED OAK TURN
HELOTES TX
78023-3875
US

V. Phone/Fax

Practice location:
  • Phone: 240-291-8313
  • Fax:
Mailing address:
  • Phone: 240-291-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number69464
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC4175
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: