Healthcare Provider Details

I. General information

NPI: 1740727254
Provider Name (Legal Business Name): CHRISTIAN OLUSOJI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2017
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N CHARLES ST
TOWSON MD
21204-6819
US

IV. Provider business mailing address

9401 SOUTHWEST FWY
HOUSTON TX
77074-1407
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2000
  • Fax:
Mailing address:
  • Phone: 713-970-7000
  • Fax: 713-970-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30643
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: